医养结合最新文章合辑
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.
Chinese Elderly Residents' Willingness to Use Integrated Medical and Nursing Care：a Meta-analysis
With aging deepening, there is an increasing demand for medical and elderly care services in Chinese older residents. However, current medical and pension services are still in a state of disconnection. In this regard, integrated medical and nursing care could continuously satisfy their multi-level healthcare needs via orderly combining medical and nursing care resources.
To comprehensively analyze the willingness of Chinese elderly residents to use integrated medical and nursing care.
The literature on the willingness of Chinese elderly residents to use integrated medical and nursing care was searched in databases including CNKI, WanFang Data, CQVIP, PubMed and Web of Science from inception to December, 2020. Data of studies satisfying the inclusion criteria were extracted and meta-analyzed. The literature quality was evaluated by using the current situation survey bias risk assessment criteria (JBI) .
A total of 20 articles were included. The effective sample size of the study was 14 089 cases, and 4 268 residents were willing to participate. The JBI scores of the literature included in the study were 14-18 points, which were greater than 70% of the total score. The quality of the literature included in the study was high. The overall rate of Chinese elderly residents' willingness to use integrated medical and nursing care was 40.5%〔95%CI (33.3%, 47.7%) 〕. Results of subgroup analysis demonstrated that educational background〔OR (95%CI) =0.71 (0.59, 0.85) , P<0.01〕, number of children〔OR (95%CI) =1.72 (1.40, 2.11) , P<0.01〕, marital status〔OR (95%CI) =0.71 (0.57, 0.88) , P=0.02〕, whether living alone〔OR (95%CI) =1.30 (1.14, 1.49) , P<0.01〕, disease prevalence〔OR (95%CI) =1.34 (1.09, 1.64) , P<0.01〕 and awareness of integrated medical and nursing care〔OR (95%CI) =1.91 (1.61, 2.26) , P<0.01〕 were associated with these residents' willingness to use integrated medical and nursing care.
The rate of Chinese elderly residents' willingness to use integrated medical and nursing care was relatively low. High school education or above, number of children≤1, unmarried, living alone, having an illness, and knowing integrated medical and nursing care were associated with stronger willingness to use integrated medical and nursing care. To improve the level of willingness, it is of great necessity to strengthen the publicity of integrated medical and nursing care, establish diversified medical and nursing care homes, and continuously enrich integrated medical and nursing care services.
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.
There are various researches about the mode and influencing factors of the integrated elderly care and medical services in China in recent years, but researches about quality of integrated elderly care and medical services in nursing institutions are limited, especially in the comparison of quality of integrated elderly care and medical services in difference types of institutions.
To evaluate the quality of integrated elderly care and medical services between public and private nursing institutions.
A total of 1 106 older adults from 25 nursing institutions in Baotou, Xi'an, Yichang and Shaoxing were selected by stratified random sampling method from October 2020 to September 2021 to conduct questionnaire survey. The SERVQUAL model was used to construct the Evaluation Index System of Integrated Elderly Care and Medical Services Quality, involving 5 dimensions of reliability, timeliness, supportability, normativity and empathy and 15 secondary indexes, entropy weight method and fuzzy comprehensive evaluation method were used to calculate and compare the service quality scores of integrated elderly care and medical services between public and private nursing institutions.
The comprehensive evaluation score of integrated elderly care and medical services quality was 41.66 and 38.82 in public and private nursing institutions, respectively, among which the scores of the 15 secondary indexes were all above 40.00 in public institutions, and the scores of 13 secondary indexes were below 40.00 in private institutions.
There is certain difference in the comprehensive evaluation results of satisfaction on the quality of integrated elderly care and medical services between public and private nursing institutions, among which the differences in the scores of normativity and empathy are higher, while the differences in the scores of reliability, timeliness and supportability are lower, providing a reference for identifying the problems in integrated elderly care and medical services and promoting its high-quality development in nursing institutions.
The need for elder care has become more pressing as population aging is accelerating in China. The General Office of the State Council of the People's Republic of China has promulgated a number of opinions between 2013 and 2021 aiming at promoting the implementation of integrated medical and elderly care services, enhancing the quality of geriatric services, and strengthening aging services in the new era. And then primary care institutions and elderly care facilities have put the issue on the critical agenda, namely how to take actions to divide labor and cooperate to ensure the elderly to get security and support. This paper discusses the importance and necessity of the model of elderly care institutions operated by community health institutions, and analyzes its benefits and drawbacks from five dimensions: service providers, service scope, service forms, service receivers, and operational effects, with the expectation of gradually implementing the actions to improve the national level of integrated medical and elderly care, to develop a high-quality community-based integrated medical and elderly care model, and to promote the concept of healthy aging.
Faced with the increasingly severe trend of population aging and the threat of non communicable chronic diseases, China actively guides and promotes the development of community embedded integrated medical and nursing care service with characteristics of traditional Chinese medicine (TCM). However, there are limited studies on performance evaluation in this field in the existing literature. The construction of a set of scientific and effective performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM has important theoretical significance and practical value.
To construct a performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM, determine the weights for indicators of each level, so as to provide reference for the formulation of relevant policies and the performance evaluation of community embedded integrated medical and nursing care service with characteristics of TCM.
From September to October 2022, a two-dimensional theoretical framework of "embedded-performance" for the community embedded integrated medical and nursing care service with characteristics of TCM was established through literature research and based on the embeddedness theory and the structure-process-outcome theoretical model. From October to November 2022, an index system was constructed based on the two-dimensional theoretical framework of "embedded-performance", with methods of literature research, Delphi method, and field investigation. In December 2022, the analytic hierarchy process was applied to determine the weight coefficients and test the logical consistency of indicators at all levels.
A performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM, containing 2 dimensions of embeddedness and embedded performance, 6 primary indicators, 19 secondary indicators, and 45 tertiary indicators was constructed. The primary indicators with the highest weight were A5 (service process) and A6 (service outcome), while the secondary and tertiary indicators with the highest combined weight were B17 (service output), B19 (service satisfaction), and C44 (elderly satisfaction). All judgment matrices have passed the consistency test with CR<0.1.
The two-dimensional theoretical framework of "embedded-performance" for community embedded integrated medical and nursing care with characteristics of TCM has strong applicability and feasibility. The performance evaluation index system constructed based on this theoretical framework has a high concentration of expert opinions, strong scientific, rationality, systematicness, hierarchy, and application value, which can provide reference for government departments to formulate relevant policies, and is an effective tool for conducting performance evaluation of community embedded integrated medical and nursing care service with characteristics of TCM.
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.
Providing continuous health services is a key task in community-dwelling integrated medical and elderly care, policy design plays a crucial role in the construction of continuous health service system, but previous research is limited in analyzing the continuous health service policy of community-dwelling integrated medical and elderly care in China.
To analyze the characteristics and shortcomings of policies of community-dwelling integrated medical and elderly care in China, and provide policy recommendations for improving the continuous health service system of community-dwelling integrated medical and elderly care.
In May 2024, search policy documents on the website "www.pkulaw.com", using the title keywords "integrated medical and elderly care" "elderly care service" "elder" "ageing", the leading department of introduction is national level (Central Committee of the Communist Party of China, State Council), or competent departments of health service (National Health Commission, National Healthcare Security Administration, National Administration of Traditional Chinese Medicine, or National Disease Control and Prevention Administration), introduced from January 2000 to May 2024, and related to continuous health service of community-dwelling integrated medical and elderly care, select as samples (n=41). Based on the indicators system of continuous health services, policy tool types, and policy effectiveness scores, establish a three-dimensional analysis framework to quantitatively analyze the policies.
The proportion of policy effectiveness scores for the indicators of relationship continuity, information continuity, and management continuity accounted for 8.62% (264/3 063), 10.61% (325/3 063), and 80.77% (2 474/3 063), respectively. The proportion of policy effectiveness scores and importance weights in the tertiary indicators were severely mismatched, with a Pearson correlation coefficient of only -0.10 (P>0.05). The effectiveness scores of market-oriented tools, business management techniques, and socialization methods account for 22.62% (693/3 063), 67.29% (2 061/3 063), and 10.09% (309/3 063), respectively. The overall average score for policy effectiveness is 12.20, while the average scores for policy effectiveness for relationship continuity, information continuity, and management continuity are 13.89, 16.25, and 11.67, respectively. The average scores for the effectiveness of market-oriented tools, business management techniques, and socialization methods policies are 16.90, 11.45, and 10.30, respectively. The average effectiveness scores of policy measures and targets are 3.25 and 2.80, respectively, with a difference of 16.07%. The overall average effectiveness score of policy measures and targets is only 3.03, close to 3.00 which is the critical value of specificity.
There is room for improvement in the effectiveness distribution, tool selection, and specificity of China's continuous health service policy of community-dwelling integrated medical and elderly care. We suggest that the effectiveness of policy should scientifically cover the continuity indicators of health service and enhance the sense of gain of elderly people in home-based communities. Increase the use of market-oriented tools and strengthen economic stimulation for market entities. Balance the effectiveness of policy measures and targets, and improve the specificity of policy.
