Vertical Integration of Electronic Health Records in Medical Consortiums: Dynamic Modeling Approach Based on the Evolutionary Game Theory

Towards a Region-Wide Glycaemic Management System: Strategies and Applications for Glycaemic Management of Patients with Diabetes During Hospitalisation

Objective

This study proposes a region-wide blood glucose management system to solve the problem of blood glucose management in patients with diabetes.

Methods

A professional team of doctors, nurses and dietitians jointly developed a region-wide blood glucose management system. The system operates through a collaborative approach where each team member utilises their specialised role, such as data monitoring, algorithm development or patient support, to contribute to a comprehensive blood glucose management network. This integration ensures accurate glucose tracking, personalised feedback and timely adjustments to treatment plans. The system allows the patient to have a good treatment plan, giving comprehensive medical guidance, and the physician team is responsible for the patient's health status.

Results

The region-wide blood glucose management system increased the overall blood glucose monitoring rate of patients and reduced the hospitalisation time (from 11.27 days to 9.52 days) and hospitalisation costs (from 12,173.8 yuan to 9502.4 yuan). At the same time, the system effectively counted the incidence and occurrence time of hyperglycaemia and hypoglycaemia adverse events, which can provide a reference for clinical prevention of adverse events.

Conclusion

A region-wide blood glucose management system can improve medical efficiency, save medical resources and provide a strong guarantee for the health of patients with diabetes. Compared with the traditional diabetes management mode, the region-wide blood glucose management system is more systematic and standardised, meaning it can better meet the needs of patients with diabetes.

Study on the interior equilibrium point of a special class of 2 × 2 × 2 asymmetric evolutionary games

Many behavioural interactions in real life involve three individuals. When each individual has two alternative strategies, they can be abstracted into mathematical models by means of2 × 2 × 2 asymmetric games. In this paper, we explore a special class of2 × 2 × 2 asymmetric games satisfying fixed conditions. Firstly, we analyse two solitary interior equilibrium points and provide the judgement condition for their instability based on the Jacobi matrix local stability analysis method. Secondly, we analyse the interior equilibrium points that are continuously distributed within a line and probe into their stability conditions based on generalized Hamiltonian systems theory. Under the circumstances, the stable interior equilibrium point is surrounded by closed orbits in phase space, which presents an observable stable state where two strategies coexist and fluctuate in each of the three game populations. This work enriches the study of2 × 2 × 2 asymmetric games' evolutionary dynamics.

Differences in influencing mechanism of clinicians' adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums

BACKGROUND

Medical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians' adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians' hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems.

METHODS

A self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization.

RESULTS

It revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01).

CONCLUSION

To effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

Objectives

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.

Methods

An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.

Results

After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).

Conclusion

The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation

Background

The construction of medical consortiums not only promotes active cooperation among hospitals, but also further intensifies active competition among them. The shared use of electronic health records (EHR) breaks the original pattern of benefit distribution among hospitals.

Objective

The purpose of this paper is to establish an incentive mechanism for the shared use EHR, and to reveal the incentive effect and mechanism of key factors, and to put forward management suggestions for solving the real conflicts.

Methods

We constructed a basic incentive model and an incentive model that introduces performance evaluation as a supervisory signal, based on analyzing the hospital cost function, the hospital benefit function, and the incentive contract function. Finally, the incentive effects of key factors before and after the introduction of performance evaluation were verified and compared using MATLAB simulation method.

Results

The profit level and incentive coefficient of hospitals sharing EHR are independent of the amount of one-time government subsidies. Regardless of whether a performance evaluation supervisory signal is introduced or not, the incentive coefficients are increasing functions with respect to ρ, τ, but decreasing functions with respect to β, δ, γ. After the inclusion of supervisory signal of performance evaluation in the model, the ability of hospitals to use EHR has a higher impact effectiveness on improving both incentive effects and benefit levels. The impact of the value-added coefficient on the level of earnings is consistently greater than it would have been without the inclusion of the performance evaluation supervisory signal.

Conclusions

Enhancing the capacity of hospitals to use EHR and tapping and expanding the value-added space of EHR are 2 key paths to promote sustainable shared use of EHR. Substantive performance evaluation plays an important role in stabilizing incentive effects.

Study on the evolutionary strategy of upward patient transfer in the loose medical consortia

Medical institutions in loose medical consortia tend to have poor cooperation due to fragmented interests. We aim to explore any issues associated with patient upward transfer in a loose medical consortium system consisting of two tertiary hospitals with both cooperative and competitive relationships. A two-sided evolutionary game model was constructed to assess the stability of equilibrium strategy combinations in the process of interaction between game players under different cost-sharing scenarios and different degrees of penalties when running patient upward transfer between super triple-A hospitals (STH) and general triple-A hospitals (GTH). We found that a hospital's stabilization strategy was related to its revenue status. When a hospital has high/low revenues, it will treat patients negatively/positively, regardless of the strategy chosen by the other hospital. When the hospital has a medium revenue, the strategy choice will be related to the delay cost, delay cost sharing coefficient, government penalty and the strategic choice of the other hospital. Delay cost-sharing coefficient is an important internal factor affecting the cooperation in a medical consortium for patient upward transfer. External interventions, such as government penalty mechanisms, can improve the cooperation between hospitals when hospitals have moderate revenue.