| ObjectiveThis study aimed to compare the effectiveness of different combinations of Traditional Chinese Medicine(TCM)treatment and western medicine interventions on children with recurrent respiratory tract infections(RRTIs)by using Markov decision processes(MDPs)theory.And we adopted the number of respiratory tract infections incidence as optimal criterions to screening the relatively optimal combination of treatment in the different state,which could be a reference for the selection of clinical practice.MethodsIt was a retrospective study based on electronic medical records(EMRs)of 0-6 years old children with RRTIs in the outpatient and emergency departments of Guangdong Province Traditional Chinese Medical Hospital in 2016 and these children’s EMRs in 2017 and 2018.The three-year consecutive records of each child was sorted out,according to the data analysis requirements of MDPs.Each year was regarded as a unit,therefore three evaluation time points were formed,2016,2017,and 2018.And we would get two "state-action-reward"stages divided by these three time points.At each time point the RRTIs states of each child was described by age,sex,the number of upper respiratory tract infections(URTIs)incidence,the number of lower respiratory tract infections(LRTIs)incidence,and the TCM syndrome type which was the most frequently diagnosed syndrome in this year.The treatment information was sorted into different types as herbal medicine,non-pharmacological treatment of TCM,antibiotics,antiviral medicine,antitussive medicine.Then,the well-developed optimality technique of MDPs theory with the finite horizon criterion to make the dynamic comparison of different treatment combinations.So we can get the optimal combination of treatment in the corresponding state.ResultsA total of 49,652 electronic-medical records of 1,879 children diagnosed with respiratory tract infections for three consecutive years were included in this study,with a male versus female ratio of 1.38:1.In terms of payment type of medical expenses,there were about 30%children with no insurance,and more than half of children with normal medical insurance.At the time of initial enrollment,that is,in 2016,children were mainly concentrated in the range of 2-5 years old,accounting for 72.54%.At the same time,the number of URTIs incidence in children were concentrated at a maximum of 5 to 8 and the number of LRTIs incidence were concentrated at 1 and below.There was no statistical difference in the composition of the number of upper or lower respiratory tract infections in 2016 between age or gender(P>0.05).The concentration range of the number of URTIs incidence in 2017 and 2018 was improved from 2016,with 0-4,while the situation of LRTIs remained unchanged.In these three years,exogenous wind and heat was the most frequently diagnosed TCM syndrome every year.In the choices of treatment,symptomatic treatment of western medicine was still the main method,but the TCM treatment was also used widely.Among them,the using of non-pharmacological treatment of TCM(such as acupoint application,pediatric Tuina,moxibustion,etc.)was more of ten.After cleaning,generalizing and analyzing the data by the MDPs model,we got the optimal combination of treatment under different states at the stage.Stage 1(2016-2017)had 88 types of optimal combination of treatment for corresponding condition of patient,and stage 2(2017-2018)had 121 types.In stage 1 and 2,for 2-5 years old boys,with the number of LRTIs incidence of 1 or less and the TCM syndrome with the most frequently diagnosis of exogenous wind or cold,whose number of URTIs incidence was 5-8,their optimal treatment was western medicine treatment,while whose number of URTIs incidence was 9-12,their optimal treatment was combination treatment of TCM and western medicine.In stage 2,for 2-5 years old boys,with the number of URTIs incidence of 0-4 and the TCM syndrome with the most frequently diagnosis of exogenous wind or cold,whose number of LRTIs incidence was 1 or less,their optimal treatment was western medicine treatment(antibiotics)while whose number of LRTIs incidence was 2 or more,their optimal treatment was combination treatment of TCM and western medicine.In stage 1 and 2,for 2-5 years old boys,with the number of URTIs incidence of 5-8 and the TCM syndrome with the most frequently diagnosis of exogenous wind or cold,whose number of LRTIs incidence was 1 or less,their optimal treatment was western medicine treatment,while whose number of LRTIs incidence was 2 or more,their optimal treatment was combination treatment of TCM and western medicine.More than 80%of the optimal combination of treatment screened by MDPs were using western medicine and TCM.At the same time,we obtained the specific intervention measures of optimal combination of treatment about TCM treatment,western medicine treatment and combination treatment of TCM and western medicine in different stages.Among them,there were 6 types of TCM treatment(2 types in stage 1 and 4 types in stage 2),15 types of western medicine treatment(4 types in stage 1 and 11 types in stage 2).In the results of stage 1,the average reward of western medicine treatment,TCM treatment,combination treatment of TCM and western medicine was 4.372 units,6.5 units,6.428 units,and in stage 2 that was 3.068 units,3.75 units,4.645 units.ConclusionThis study obtained the basic situation and treatment characteristics for children with RRTIs in the outpatient department of this hospital,which were similar with those participants in a number of other clinical studies.We screened the optimal combination of treatments based on MDPs theory and concluded that,for 2-5 year-old boys with RRTIs whose TCM syndrome type was exogenous wind or cold(which was the most frequently diagnosed syndrome in 2016),their optimal treatment would vary by different condition.For some children with more respiratory tract infections incidence,the effect of the combination of TCM and western medicine would be better than using western medicine alone.And for some over 2 year-old children with fewer respiratory tract infections incidence,whose number of LRTIs incidence was 1 or less,they might consider using TCM alone as optimal treatment in some situations.In stage 1,for part of 2-8 year-old boys with RRTIs whose number of URTIs incidence was 5-12,number of LRTIs incidence was 1 or less,and TCM syndrome type was exogenous wind or cold/heat(which was the most frequently diagnosed syndrome in 2016),their optimal treatment were using non-pharmacological treatment of TCM alone.In stage 2,for 0-2 year-old girls with RRTIs whose number of URTIs incidence was 0-4,number of LRTIs incidence was 1 or less,and TCM syndrome type was exogenous wind and heat(which was the most frequently diagnosed syndrome in 2017),their optimal treatment were using non-pharmacological treatment of TCM alone.For part of 5-8 year-old boys with RRTIs whose number of URTIs incidence was 5-8,number of LRTIs incidence was 1 or less,and TCM syndrome type was others(which was the most frequently diagnosed syndrome in 2017),their optimal treatment were using herbal medicine of TCM alone.For part of 0-8 year-old boys with RRTIs whose number of URTIs incidence was 0-12,number of LRTIs incidence was 1 or less,and TCM syndrome type was internal injuries(which was the most frequently diagnosed syndrome in 2017),their optimal treatment were using non-pharmacological treatment and herbal medicine of TCM.In summary,we initially obtained the different optimal treatment plan for children with RRTIs in different characteristics,and explored the clinical optimal treatment scheme by using the MDPs theory,which is worthy of reference and evidence for medical decision in clinical practice.It would be meaningful to take more study and pay more attention to the good effectiveness of TCM treatment or the combination treatment of TCM and western medicine for children with RRTIs.However,the optimal treatment plan obtained by the MDPs theory will still require further validation in clinical practice. |
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