Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient respo...Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.展开更多
Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with prim...Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.展开更多
文摘Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.
文摘Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.
