ObjectiveTo explore the prevalence and risk factors of hypertension and diabetes in floating population in Hubei province, so as to provide reference for the prevention of chronic disease of floating population. MethodA multi-stages sampling was performed among six counties in Hubei province in 2012, according to the different occupations. A questionnaire survey was conducted to collect the demography, sociology and health-related behavioral characteristics of subjects. Then a univariate analysis and a multivariate analysis were conducted by SPSS 20.0 software. ResultsA total of 1 800 individuals were surveyed, and the prevalence of hypertension and diabetes in floating population was 22.7% and 4.9%, respectively. Univariate analysis indicated that significant associations were found between hypertension and such factors as age, occupations, smoking and life satisfaction (all P values < 0.05); and significant associations were found between diabetes and such factors as occupations, educational level and BMI (all P values < 0.05). The results of further logistic regression analysis showed that age (OR=2.194, 95% CI 1.940 to 2.483, P=0.001) and life satisfaction (OR=0.291, 95% CI 0.248 to 0.341, P=0.002) were independent risk factors of hypertension, and educational level (OR=3.219, 95%CI 2.016 to 7.565, P=0.011) and gender (OR=0.568, 95% CI 0.323 to 0.999, P=0.049) were independent risk factors of diabetes. ConclusionsThe prevalence of hypertension and diabetes are relative high in floating population of Hubei Province. Increasing age and low life satisfaction are independent risk factors of hypertension in floating population, while male and low educational level are independent risks factors of diabetes.
This paper introduces the background and research design (including site of investigation, study population, baseline survey and follow-up monitoring), which belongs to the Precision Medicine Project of the National Key Research and Development Program of China.
At present, the health management of chronic diseases in China is still in its infancy. In the face of an increasingly large group of patients with chronic diseases, large general public hospitals often lack a systematic and standardized chronic disease continuity management system. In order to solve the problem of patients’ medical difficulties, popularize the hospitals’ innovative medical services, and promote the professional development of clinical departments, taking the continuous health management model of chronic diseases constructed by West China Hospital of Sichuan University as an example, this paper introduces the background, organizational structure and service process of the system construction in turn. The purpose is to build a new health service model of “smart hospital”, and also provide a reference for the construction of standardized chronic disease management system in hospitals, which will lay a foundation for further constructing a top-down chronic disease whole process system linked with communities and hospitals in the later stage.
Chronic disease is a major threat to human health. Fundus disease has become a major ophthalmic disease affecting daily life. Although great breakthroughs have been made in the treatment, compared with other chronic disease management, the management of patients with fundus disease is still in its infancy. To strengthen the management exploration of patients with fundus diseases, establish a management model of fundus diseases and strive to improve patients' awareness of fundus diseases and adherence to treatment and follow-up are the great challenges at present. All ophthalmic centers should strengthen patient education, establish a regional cooperation network, support the construction of grassroots medical capacity, cultivate talents, enhance training, promote the standardized treatment of fundus diseases, standardize fundus imaging inspection and diagnosis, and promote the homogeneous construction of diagnosis and treatment of chronic fundus diseases. We will accelerate the construction of a hierarchical diagnosis and treatment system and the ability to link consultation and referral. Through systematic management and intervention of fundus diseases, a large number of patients with fundus diseases will receive early screening, diagnosis, standardized continuous treatment and systematic management, and improve the quality of life of patients with fundus diseases.
ObjectiveTo systematically review the efficacy of discharge preparation service in elderly patients with chronic diseases.MethodsCNKI, WanFang Data, VIP, Web of Science, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect randomized controlled trails (RCTs) on the discharge preparation service for elderly patients with chronic diseases from January, 2000 to January, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs, involving 884 patients were included. The results of meta-analysis showed that: after the hospitalization preparation service, the incidence of acute complication (RR=0.38, 95%CI 0.15 to 0.98, P=0.04), patient compliance behavior (SMD=0.54, 95% CI 0.25 to 0.83, P=0.000 3), exercise capacity (SMD=2.65, 95%CI 0.25 to 5.04, P=0.03), and nursing satisfaction (SMD=0.71, 95%CI 0.10 to 1.33, P=0.02) significantly improved. However, there were no significant differences in emergency hospital admission for acute complications (RR=0.25, 95%CI 0.06 to 1.11, P=0.07), self-care ability (SMD=2.18, 95%CI −1.02 to 5.38, P=0.18), activity of daily living (ADL) (SMD=0.56, 95%CI −0.47 to 1.59, P=0.28).ConclusionsThe current evidence shows that after implementation of the discharge preparation service, the incidence of acute complication, compliance behavior, exercise ability, and service satisfaction of the elderly patients with chronic diseases are significantly improved. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
The new coming era has brought great challenge to present health service model, and the development of new science and technology had improved the reconstruction of medical system and model. With the guidance of evidence-based management and participation of model technology, this paper provides an explanation of the new health service model containing new health management, clinical medicine, chronic disease management and elder care which cover the whole life cycle, so as to implement the " Health China” strategy and develop a whole life cycle health service system for all residents with necessary, high quality, and affordable prevention, treatment, rehabilitation and health promotion.
Patients with chronic diseases usually face severe challenges during their transition from hospital to home, such as poor discharge preparation, the increased incidence of medical errors, insufficient self-care capability, and poor participation in healthcare decision, which can result in increased readmission and poor patient safety. This paper reviews the definition of transitional care, single-element transitional care intervention strategy, and multiple-element transitional care intervention strategy, in order to provide new insights into the development of effective and safe transitional care strategies in China.
Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it is a key ocular fundus disease that needs to be paid attention to in the next five years according to the "14th Five-Year" Plan for Eye Health. Promoting the systematic management of DR and constructing the chronic disease management system are the key to the next step of national eye health work. It is necessary to further improve the management mode of the whole course of DR patients with chronic eye disease through the joint action of medical security system at all levels, including strengthening supporting policies of primary medical institutions, optimizing medical service mode and process, strengthening scientific education to improve patients' and doctors' disease cognition, and updating authoritative Chinese DR guidelines to standardize diagnosis and treatment. It is hoped that the low vision and blindness caused by DR in China can be greatly reduced after the implementation of the "14th Five-Year" Plan for Eye Health.
The 14th Five-Year Plan for National Health explicitly proposes elevating the comprehensive prevention and control strategy for chronic diseases to the national strategy, aiming to address the growing demand for long-term management and individualized treatment of chronic diseases. In this context, the adaptive treatment strategy (ATS), as an innovative treatment model, offers new ideas and methods for the management and treatment of chronic diseases through its flexible, personalized, and scientific characteristics. To construct ATS, the sequential multiple assignment randomized trial (SMART) has emerged as a research method for multi-stage randomized controlled trials. The SMART design has been widely used in international clinical research, but there is a lack of systematic reports and studies in China. This paper first introduces the basic principles of ATS and SMART design, and then focuses on two key elements of the SMART design: re-randomization and intermediate outcomes. Based on these two elements, four major types of SMART designs are summarized, including: (1) SMART designs in which the intermediate outcome corresponds to a single re-randomization scheme (the classical type), (2) SMART designs in which no intermediate outcome is embedded, (3) SMART designs in which the intermediate outcome corresponds to a different re-randomization scheme, and (4) SMART designs in which the intermediate outcome and the previous interventions jointly determine the re-randomization. These different types of SMART designs are appropriate for solving different types of scientific problems. Using specific examples, this paper also analyzes the conditions under which SMART designs are applicable in clinical trials and predicts that the mainstream analysis methods for SMART designs in the future will combine frequentist statistics and Bayesian statistics. It is expected that the introduction and analysis in this paper will provide valuable references for researchers and promote the widespread application and innovative development of SMART design in the field of chronic disease prevention, control, and treatment strategies in China.
With the promoting of “the Belt and Road Initiative”, medical assistance to Xinjiang is one ofthe important tasks of public hospitals in China. West China Hospital of Sichuan University actively explores the“Huaxi-Karamay” model of multi-disciplinary group assistance and scientific and technological assistance to Xinjiang, and leverages the technical leadership and leading role of medical experts to improve the medical and health service capabilities of Karamay, especially in chronic diseases management. This article takes the People’s Hospital ofKaramay City in Xinjiang province as an example to discuss the exploration and practice of the new chronic diseasemanagement model of the endocrinology and metabolism center with medical assistance from West China Hospital ofSichuan University, aiming to provide a certain reference for the in-depth development of medical aid to Xinjiang in thefuture.