Analysis Of Disease Burden Of Two-way Referral Patients Based On Implementation Of Telemedicine Services

Background The western region of China is sparsely populated with scarce medical resources,and it is difficult for patients to seek medical treatment and medical expenses are high.In 2012,a city in the western region began to implement telemedicine as a pilot project for national science and technology-for-profit projects,and set up a medical consortium to realize a hierarchical diagnosis and treatment model.Two-way referral as one of the modes of grading diagnosis and treatment can effectively improve the utilization rate of medical resources,save the medical expenses of patients,and alleviate the problems of “difficult and expensive” in China.At the same time,various regions also continued to explore the implementation of a two-way referral model.In the past,most of the studies on two-way referral focused on concepts and systems.This study is based on the analysis of the patient's disease burden in the two-way referral process based on telemedicine services and is of great significance in promoting the implementation of two-way referral.Objectives To understand the basic operation conditions of the sample hospitals and the changes in the referral rate.To analyze the disease costs of the representative disease spectrum on the basis of understanding the disease spectrum of the sample hospitals.To establish an index system to comprehensively analyze the disease costs incurred by patients during their hospitalization,in order to provide sustainable development advice for sample hospitals.Methods The literature review method was used to understand the basic operation of the sample hospital.Descriptive analysis was used to analyze patient referral rates,disease spectrum, and representative disease spectrum disease costs in sample hospitals.Gray correlation method.A comprehensive analysis of the patient's disease costs was made on the basis of the establishment of a disease burden index system using the grey correlation method.Results1.The rate of referral to hospitalized patients decreased Through the implementation of telemedicine,the referral rate of inpatients is effectively reduced.From 2013 to 2016,the total number of patients discharged from sample hospitals reached 103,231,of which 4773 were cumulatively transferred,and the referral rate was4.62%.The cumulative number of discharged patients was 20637 and the referral rate was19.99%.In 2016,the number of discharged people increased by 8666 compared with 2013,and the number of people who turned in increased by 16 persons.The referral rate decreased by 1.35%;the number of people who turned down increased by 763 and the referral rate decreased by 3.64%.2.Profile of disease spectrum According to the level of the average cost,10 kinds of disease in 4 years were selected from the 20 diseases in 2013-2016,including brain stem bleeding,lung infection,abdominal aortic aneurysm,thoracic vertebral fracture,and acute severe pancreas Inflammation,hip prosthesis loosening,coronary atherosclerotic heart disease,secondary brain malignancy,hypertension III,and nephrotic syndrome.3.The average cost of inpatients of various diseases showed a significant decline The average annual growth rate of patients with midbrain dry bleeding from 2013 to2016 was-71.33%,the annual growth rate of lung infections was-2.63%,and the annual growth rate of abdominal aortic aneurysms was-4.36%.The average annual growth rate of patients with severe acute pancreatitis is-8.57%.The average cost of hip joint prosthesis loosening,sternum fracture and nephrotic syndrome has a larger range of changes,but the overall trend is decreasing.The annual growth rate of the average cost of coronary heartdisease is-6.07%,the annual growth rate of brain-initiated malignant tumors is-26.94%,and the annual growth rate of hypertension in patients with stage III hypertension is-9.37%.4.Through the implementation of telemedicine services,the patient's disease burden is reduced The average total cost of hypertension,artificial organ replacement and other representative diseases from the grassroots level to the central hospital,the central hospital to the district hospital,the central hospital to Beijing and other out-of-area hospitals are getting higher and higher.The average total cost of medical visits to Beijing was 3 times higher than that of central hospitals,and 1.3 times higher than that of district hospitals.Through the implementation of telemedicine services,the hospital's referral rate and patients are reduced every year on average,which saves medical expenses and medical travel expenses for patients in and around the region.5.Using the grey correlation method,the main factors influencing the patient's hospitalization cost are the treatment fee,anesthesia fee,other expenses,antibiotic costs and drug costs,and the correlations are 0.898,0.880,0.850,0.793,and 0.790,respectively.Recommendations1.Introduce advanced technologies to improve hospital medical services and reduce the referral rate2.Strengthen the construction of special departments to make specialization and diversification of disease treatment3.Hospitals should strengthen the control of fees,reduce the patient's medical expenses,and reduce the patient's medical burden4.Strengthen the publicity work of the local two-way referral system and change the patient's medical habits...