At present, the aging situation in China is becoming increasingly severe. The elderly are facing difficulties in acquiring elderly service and medical care in the process, in which the elderly need digital service of the combination between medical and nursing care urgently. However, there still exist some problems of the combination of medical and nursing care in the present stage, such as imperfect models, low level of intelligence, inefficient integration mechanism of resources related to "medical care" and "nursing care", and the inadequate phenomenon in which the service of combination of medical and nursing care leads to "the castle in the air". In view of the current difficulties and blocking points in the combination of medical and nursing care, the research team of this paper use digital and intelligent methods to construct 5 types of smart medical and nursing service models, including "full chain" "multi-subject integration" "active health" of traditional Chinese medicine, "return to the community" and "return to the home". Furthermore, the research team issused 6 group standards, seted up 2 landmark projects, and established more than 20 demonstration application bases across the country in the meantime as well as incorporate 500 community/township promotion plans of Henan Provincial government, which achieve good demonstration effects. This paper briefly introduces five types of model specifications from four aspects of model conception, model composition, model operation mechanism and model function, so as to facilitate the further study and popularization of the five models.
In the context of "comprehensively promoting the construction of a healthy China" and "actively responding to the national strategy of aging population", scientific evaluation of the performance of community embedded integrated medical and nursing care with characteristics of TCM is the key to improving the quality of integrated medical and nursing care.
Evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM and analyze main obstacles, providing practical basis for government departments to formulate relevant policies and carry out performance evaluation of it.
In November 2022, the performance evaluation index system for community embedded integrated medical and nursing care with characteristics of TCM was transformed into three questionnaires: basic information of the institution, satisfaction of staff and the elderly. From November 2022 to January 2023, a questionnaire survey method was used to collect basic data from 10 sample institutions, as well as satisfaction data from staff and the elderly. From February to March 2023, the TOPSIS method was used to evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM, and the obstacle degree model was used to analyze the main obstacle factors of service performance.
The overall embeddedness, structural embeddedness, relationship embeddedness, and embedded performance Cn of the 10 institutions are ranked consistently, 7 institutions have the same ranking of cognitive embedding and embedding performance Cn, and the ranking is consistent with the service performance Cn of each institution. The main obstacles to the performance of community embedded integrated medical and nursing care with characteristics of TCM are C33 (number of TCM health care guidance services), C44 (elderly satisfaction), C8 (institutions and partners adhere to win-win cooperation), C37 (the proportion of TCM non pharmacological therapy rehabilitation nursing personnel), C39 (number of elderly people served) .
The embeddedness, structural embeddedness, and relational embeddedness of community embedded integrated medical and nursing care with characteristics of TCM have a positive impact on its embedding performance. Cognitive embedding has a basic positive impact on embedding performance. Government departments should clarify their functional positioning, strengthen policy support, improve the evaluation system, pay attention to dynamic evaluation, and guide and promote the high-quality development of community embedded integrated medical and nursing care with characteristics of TCM. Institutions with characteristics of TCM should strengthen their structural embedding, relationship embedding, and cognitive embedding with partners, in order to continuously improve their service performance, to meet the diversified and multi-level health care service needs of the elderly in home communities. At the same time, should grasp the degree of embedding, so as not to produce the negative effect of embedding.
The degree of aging in China is constantly deepening, and the demand for medical and nursing care services among residents is increasing day by day. Exploring how the integrated medical and nursing care services can develop efficiently with high quality is of great practical significance for actively responding to the aging population.
This study provided a reference for improving the service efficiency and optimizing resource allocation by analyzing the efficiency evaluation of the integrated medical and nursing care services in Beijing's nursing homes.
The output-oriented BCC model in Data Envelopment Analysis (DEA) was used to evaluate the technical efficiency, pure technical efficiency, scale efficiency of the integrated medical and nursing care services of 62 nursing homes in Beijing. Input indicators: number of institutional beds, number of medical staff, number of elderly caregivers (carers). Output indicators: number of totally disabled/severely impaired elderly, number of partially disabled/mildly impaired elderly, and number of self-care elderly.
It is found that in the technical efficiency, pure technical efficiency, and scale efficiency of 62 nursing homes in Beijing, the proportion of DEA effective unit is 12.903%, 35.484% and 12.903% respectively. The average values of technical efficiency, pure technical efficiency and scale efficiency are 0.599, 0.788 and 0.760 respectively. Among them, 12.903% of nursing homes are in the state of constant returns to scale, 70.968% are in the state of decreasing returns to scale, and 16.129% are in the state of increasing returns to scale.
The overall service efficiency of nursing homes in Beijing is low, and there are phenomena of resource waste and mismatch between supply and demand. It is suggested that nursing homes should scientifically locate the target group, provide accurate services, reasonably calculate the input capacity, and promote service cooperation between the hospital and the nursing home. The government should continue to implement the further implementation of relevant support policies.
