| Background: The Anhui Luan region end-to-end telemedicine project was operationed August,2015,which was supported by the National Ministry of Science and Technology Project,this project includes two sides,the first affiliated hospital of anhui medical university remote consultation terminalis the provincial center platform and the 23 pilot hospital remote consultation terminal for bottom allied platform.which includes seven counties or districts and sixteen villages or towns.this two sides realize remote consultation through the Internet technology,becsuse of remote consultation luan people can enjoy high quality and efficient medical and health services as the provincial level,to achive an aim which means ailment is not out of the township and a serious illness is not out of the county.This Project has been carried out seven hundred and fourty-two cases,of which 450 cases in the county or district and 292 cases at village or town.To understand the project running effect,this study begins to analyze from the related party of remote consultation,and shows the advantages and meanings of using the remote consultation,besides,this results can put forward the corresponding strategies and the empirical basis for the remote consultation work.Purpose: 1.three hospitals at the county level and their subordinate three towns and townships are chooseed to analyze the application distribution upon the Luan region end-to-end project;besides,understand these physicians and patients' s satisfaction by survey,and understand the remote consultation conducted by the effect and problems in the execution through interview.2.through the contrast research,compare the clinical effect differences at diagnosis and treatment between user and unuser of remote consultation.3.Calculate the benefits of remote consultation,including economic benefit,social benefit,the external influence,economies of scale from the related party of remote consultation,which relys on the remote consultation system,China and anhui statistical yearbook.with the purpose of to promote the sustainable development of the remote consultation and provide reference basis for the hospital management department and health care workers.Methods: 1.Through literature review and expert consultation,design a set of remote consultation questionnaires and interview outline.According to the principle of representativeness,six pilot hospitals including two hundred and fifteen patients,eighteen-six physicians,and one hospital leaders and two executive are choosed to to participate in this investigation from August 1,2015 to May 30 2016.Then use Epi Data3.1 for data entry and Spss21.0 statistical software for data analysis.2.Obtain economics related data from the survey hospital consultation center,Combining with the interview data,then analyze the application distribution of using remote consultation between this six survey hospitals in Luan.3.Choose the jinzhai county people's hospital as the survey example,according to the standard international classification of diseases(ICD-10),some discharged patients were randomly selected as the research object,which matched by the same age ? sex ? disease and illness similarity,the inclusion criteria is this patients who was in hospital and diagnose the same patient after admission from August 1,2015 to 2015 on May 31.then 90 patients as the application group those use the remote consultation,as the same time 180 patients as control group those without the remote consultation.some relevant health indicators were calculate,including the time and expense of every patient,the diagnosis coincidence rate,treatment efficiency.4.Obtain some relevant data from the remote consultation center or the statistical yearbook,as the perspective of consultation related party to calculate economic benefits and social benefits,analyzed the external influence and social compensation funds which is produced by the using the remote consultation.Results: 1.the application distribution:(1)usage number.six pilot hospitals have beenfinished 503 cases until May 30 of 2016,usage varies widely among different hospitals,and usage of huoshan county is the most while Dahua chemiacl ping town center hospital is the least;(2)the dynamic change of usage number.the medium-term is the most while the late-term is the least;besides,two Investigation provinces usage changes are slightly different,which show the jinzhai usage has been increasing,but the growth rate gradually decreased;The use amount of huoshan county has been decreasing,and decline rate increase;(3)regional distribution,jinzhai county's usage is nearly 2 times than huoshan county;The purpose of consultation is approximately the same between this two counties;The nature of the illness,order from large to small is difficult,in general,critically ill,emergency patients;In the primary department usage,order from large to small is surgery,internal medicine,gynecology and obstetrics,emergency department,and pediatrics.2.the questionnaire survey results: the total satisfaction of patients and physicians is high,as the number is respectively 88.5%?88.5%;support rate of patients and physicians is respectively 75.1%?97.6%;think the price is reasonable of patients and physicians is respectively 24.9%?40.5%.Among other things,60.8% of patients are willing to use remote consultation again and introduce friends to use remote consultation;the purpose of applying for doctor's consultation is to get a clear diagnosis(52.4%)or consult treatment(44%).3.compare the results of the study:(1)the average hospitalization days.the average time of the application group and the comparison group is 12.34 days and 15.02 days,these difference between two groups was statistically significant(t = 4.611,P = 4.611,P <0.05),and the application group's is lower than the contrast group's;(2)the average hospitalization expense.the average hospitalization expense of these two groups is10871.79 yuan and 13042.60 yuan,these difference between two groups was statistically significant(t = 2.839,P = 2.839,P < 0.05),and the application group's is lower than the contrast group;(3)the diagnosis coincidence rate.the rate of the application group and the comparison group is respectively 92.2% ? 87.2%,these difference is statistically significant(?2= 205.793,P = 205.793,P < 0.05),and the application group's is higher than the contrast group's;(4)the efficient treatment.The number of the application group and the comparison group is respectively 80.0% ?87.2%,these difference is statistically significant(?2= 151.274,P = 151.274,P < 0.05),and the application group's is higher than the contrast group's.4.Benefit analysis results:(1)the economic benefits,reduce the medical cost of patients and reduce social compensation funds.The project has finished 742 cases till now,including 450 patients of county district hospitals and 292 patients of township-level hospital,patients with local treatment can balance the cost of 4.799 million yuan,the county district hospital patients save 6457.4 yuan per capita,the township-level hospitals save 7901.8 yuan per capita;Patients with local treatment can save the total transportation is 179100 yuan and total accommodation for 1.4843 million yuan.So the total of 1.6634 million yuan is spared and every patient can save 2241.51 yuan.At the same time,of these 742 patients,there are 665 patients are involved in all kinds of insurance,The cost of social security payment can save 12.8731 million yuan with local treatment,which contains 145900 yuan for the urban worker and 624700 yuan for urban residents and 12.1025 million yuan for New Rural Cooperative Medical System(NCMS).so namely using remote consultation can save 12.8731 million yuan compensation funds for the society.(2)social benefits: remote consultation will be contribute to to solve the problem of medical treatment cost and to improve the grassroots medical technology,and get high praise between the patients and physicians.With remote consutation these physicians can obtain targeted technical guidance.at the same time,grass-roots doctors can communicate with superior expert by remote consutation,expand training channels for grass-roots doctors and promote the collaboration between the hospital and sharing of medical resources in the area of communication.(3)the external influence: remote consultation has certain positive meaning.for patients and their families,medical workers,hospitals,government and society.Using the remote consultation can greatly reduce the cost of patients,help doctors improve the diagnostic rate and cure rate at the grassroots level to grassroots medical institutions out ability,shunt provincial hospital patients,hospitals at all levels function and classification of diagnosis and treatment pattern,which all is conducive to social harmony and stability.(4)economies of scale:The operating costs of remote consultation system is fixed in a certain period,if increase the usage the operation cost can be reduced,so,increase the usage of the remote consultation can reduce costs and increase profits within a certain range,in the other ways,with a large-scale of remote consultation within a certain scope,it can produce large scale economic benefit,forming good social effect.Conclusions and Suggestions: There are many earnings: increase patients and their families' satisfaction with the medical treatment process;decrease the time and expense of every patient and increase the diagnosis coincidence rate and treatment of patients with efficient in their medical activities;Reduce the patients' medical costs,save social compensation funds,widen the channel of the on-the-job medical personnel training,improve medical resources sharing between medical institutions and promote exchanges and cooperation in economic and social benefits.Besides,benefit the operation of the hierarchical diagnosis and referral,and thus transform the medical function dislocation,contribute to quality of the hospital health resources rational allocation,increase the utilization ratio of health resources.some measures should be taken,such as Strengthen the work of propaganda,improve some supporting measures;Improve the content and projects of remote consultation services;Improve the process management and to promote the usage and efficiency,and then enhance remote consultation system's service ability and quality;Improve informatization construction actively and constantly;Develop relatively flexible consultation rules and regulations on every hospital's condition,formulate long-term consultation operation mode;Innovative the remote consultation's operation mode.Multi-angle comprehensive promote healthy,remote consultation work reasonably and sustainable development. |
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