This study aims to explore the application value of nursing decision support system model in clinical practice based on medical big data mining. Multi-source medical data set, data preprocessing and integration technology are used to construct decision support model by machine learning algorithms. The results demonstrate that the model shows high accuracy in predicting nursing needs, changes of patients' condition, and responding to random events, which could effectively reduce the workload of nursing staff and improve the precision and response speed of nursing care. By deeply mining patient data, the system provides personalized recommendations for care to promote patient health outcomes.

Objective To understand the occurrence of sexual behaviors among female college students in Shanxi Province, and to explore the correlation between the age of first sexual behavior and HIV-related high-risk sexual behaviors, so as to provide a basis for sex education among college students in Shanxi Province in the future. Methods Female college students (undergraduates and postgraduates) in Shanxi Province were selected as the subjects by cluster sampling method, and the subjects were invited to fill in the questionnaire anonymously online. Results A total of 488 female college students participated and completed the questionnaire.The average age of the subjects was (22.98±0.62) years, and the incidence of sexual behaviors was 23.6%.There were statistically significant differences in the occurrence of sexual behaviors of the subjects in different age groups (P<0.001).82.0% of the subjects received sex education.41.7% had their first sexual encounter in college, 40.0% in high school, and 18.3% in middle school.Among them, subjects who had first sexual encounter with the opposite sex in college accounted for 97.9%.The use rate of condom for first sexual encounter was 70.8%, and 64.6% preferred to take other measures as contraception.77.1% had less than two sexual partners in the past year, and the rate of condom used frequently and each time in sexual behaviors in the past year was 77.1%.Compared to that, the subjects who had their first sexual intercourse before college had the characteristics of not using a condom for the first sexual behavior(P<0.001), being more inclined to use condoms as contraception (P<0.001), having ≥2 sexual partners in the last year (P=0.002), and never or occasionally using condoms in the last year (P=0.009). Conclusions Female college students in Shanxi Province have higher incidence of sexual behaviors and more HIV-related high-risk sexual behaviors, and those who have their first sexual behavior earlier are more likely to have HIV-related high-risk sexual behaviors.

Both DIP and DRG are tools of disease classification based on ICD-10 for diagnosis and ICD-10-CM for clinical procedure, and they share the commonality of case-based payment. The difference is that the granularity of diagnosis and operation is different, resulting in different numbers of disease groups and differences between disease groups, and the different impacts on clinical behaviors, medical management and the allocation of health insurance funds. Through the comparison of empirical data in some regions, it is found that DRG payment is more conducive to the compensation and control of unreasonable medical behaviors in health facilities. By comparing the historical development and evolution of DRG groups in the United States, European countries and Japan, this paper evaluates the relative positions of DRG and DIP groups in China, and provides ideas for the reform of medical insurance payment in China.

Objective In the context of the reform of the support mechanism for covering outpatient medical bills under the employee basic medical insurance, this paper analyzes the current policy and actual progress of integrating designated retail pharmacies into risk pooling of outpatient services in Shandong Province, so as to provide the reference for the follow-up policy improvement. Methods From February 15, 2023 to March 31, 2024, policy documents of pharmacies included in risk pooling of outpatient services in 16 prefecture-level cities in Shandong were retrieved and collected for qualitative description and quantitative analysis to summarize the current progress, policy models and existing problems in each city. Results As of February 2024, eight prefecture-level cities in Shandong Province have issued specific documents on the designated retail pharmacies included in risk pooling of outpatient services. A total of 235 pharmacies included in risk pooling of outpatient services accounted for 0.6% of the total number of designated retail pharmacies. The selection of pharmacies was carried out in all 16 prefecture-level cities according to the model of encouraging inclusion. At present, while the electronic prescription transfer has not been fully realized, these areas adhered to the same basic medical insurance benefits policy as that of designated primary medical institutions in the overall planning area. Deductibles ranged from 0 to 200 yuan across prefecture-level cities, and the maximum payment limit for employees was more than 4, 500 yuan in 70% of prefecture-level cities. Conclusions The selection criteria of pharmacies in different cities are generally consistent, but the quantity is still inadequate. The lack of incentive for prescription transfer and the improvement of benefits in the risk pooling of outpatient services may have an impact on the pattern of medical treatment, and heighten competitive pressures in the market for pharmacies. It is recommended to further do the layout planning and management of pharmacies included in risk pooling of outpatient services, promote the transfer of electronic prescriptions, establish an incentive mechanism for the management of reasonable drug price, and enhance the service ability and level of pharmacies included in risk pooling of outpatient services.

Objective This paper analyzes the current situation and expectation of health workers' satisfaction with salary in public hospitals in the pilot city launched salary system reform, so as to provide the reference for deepening the reform of salary system in public hospitals. Methods A sample questionnaire survey was conducted among 743 health workers from ten municipal public hospitals in Shenzhen, and the results were described and tested statistically. Results A total of 674 valid questionnaires were collected. The overall scores of satisfaction with salary and merit pay were 2.77±1.11 and 2.88±1.11, respectively. The staff with intermediate professional titles, 6-10 years of work and relatively low monthly income were more dissatisfied with their overall salary(P<0.05). The staff with less than five years of experience, higher monthly income and contract employees presented greater satisfaction about merit-pay (P<0.05). The distribution of merit pay and the proportion of fixed pay were the most concerned elements of pay structure for health workers. The actual proportion of fixed pay (26.0%) was significantly lower than the expected proportion of pay (50.0%). Conclusions Currently, the satisfaction with salary and the proportion of fixed pay of health workers in public hospitals in Shenzhen need to be improved. There are differences in the satisfaction with overall salary among health workers with different professional titles, different years of experiences and different income levels. There are differences in the satisfaction with merit pay among health workers with different marital status, different years of work, different income levels and different employment forms.

With the application and continuous expansion of artificial intelligence in the medical field, many legal questions have arisen, such as the recognition of the main body of tort liability for medical damage caused by medical artificial intelligence. From the perspective that there is no independent consciousness of medical artificial intelligence and it is not feasible to carry out property penalties for medical artificial intelligence, the article analyzes that artificial intelligence can not bear tort liability, and does not have the constitutive elements of the main body of tort liability for medical damage. Therefore, the tort liability for medical damage caused by the application of artificial intelligence should be borne by the holder of medical artificial intelligence or medical institutions.

Objective To systematically evaluate the effectiveness of China's DRG/DIP payment reform on the medical service capacity of medical institutions. Methods Databases including PubMed, Embase, Web of Science, CNKI, CBM, WanFang Data and VIP were retrieved, and all the retrieved literature were screened based on predefined inclusion and exclusion criteria. The quality evaluation of the literatures conforming to the research was carried out. Thematic synthesis was employed to make a comprehensive analysis of the literature included in the research scope, forming a core theme and three evaluation indicators. Results A total of ten studies were included, and the scores of literature quality were 14 or above, with a total of 716, 721 subjects. The results of systematic evaluation showed that compared with the non-DRG /DIP group, the CMI value (P<0.05), the total weight and the number of DRG groups increased in the DRG/DIP group. Conclusions The implementation of DRG/DIP payment system can effectively improve the medical service capacity of medical institutions, but there is still room for improvement. It is imperative to optimize the quality system of the front page of medical records, give play to the evaluating function of CMI index, improve service quality and patient satisfaction, so as to promote the long-term development of medical institutions.

Objective To systematically evaluate the impact of the DRG payment reform on the performance of medical services in China, and to provide the reference for the reform of medical insurance payment method in China. Methods Empirical research literatures on the impact of DRG payment reform on the performance of medical services was collected by searching Web of Science, PubMed, Embase, CNKI, WanFang Data, VIP and CBM databases. Data were screened and extracted based on the inclusion and exclusion criteria, and thematic synthesis method was used to conduct a comprehensive analysis of the included literatures, forming three core themes and six evaluation indicators. Results A total of 13 literatures were included, including seven ITS studies, five BA studies, and one RCT study. The statistical results showed that after the implementation of DRG, the capacity, efficiency, quality and safety of medical services have been improved. The hospital's CMI index, the number of DRG groups, and the total weight of DRG showed an increasing trend, indicating an increase in the capacity of medical services. The time consumption index and cost consumption index showed a decreasing trend, indicating improved efficiency of medical services. The mortality rate in the low-risk group decreased, indicating improved quality and safety of medical services. Conclusions DRG is beneficial to improve the performance of medical services, thereby enhancing the fine management level of hospitals. However, there is a problem of insufficient connection with the national monitoring analysis of the performance appraisal.

Taking Guangxi as an example, this paper introduces the general situation and effect of the construction of three national regional medical centers, and summarizes the experiences from top-level design, resource coordination, implementation of responsibilities and guarantee, a system of innovation, strengthening supervision and efficiency. The practice of Guangxi reminds us that the construction of national regional medical centers should take the actual demand as the guide to plan the layout, deepen the reform of the management system, promote homogeneous management, innovate the talent management model, coordinate the development of medical education and research, and enhance the regional influence.

Objective To analyze and discuss the influencing factors of overspending cases in FM19 disease group in public tertiary hospitals in Chongqing, and to provide ideas for medical institutions and relevant departments to strengthen the control of overspending cases. Methods The relevant data of 6,747 patients in FM19 disease group with DRG settlement in public tertiary hospitals in Chongqing were collected from January 1, 2022 to March 31, 2023. Descriptive statistical analysis, single factor analysis, multiple logistic regression analysis and association rules analysis were used to analyze the factors affecting the overspending of DRG cases. Results Disease factors (types of diseases, previous medical history of percutaneous coronary intervention) and socioeconomic factors (types of medical insurance, hospital length of stay, the number of stents, the number of treated vessels, and whether other procedures were combined) were significant influencing factors of overspending cases with DRG settlement (P<0.05). Further association rules analysis showed that overspending cases with DRG settlement were most likely to occur when patients had multiple socioeconomic factors. Conclusions Medical institutions should focus on patients who meet the conditions of strong association rules, strengthen the management of interventional surgery path planning by standardizing the diagnosis and treatment process, establish an internal review mechanism to adjust and improve clinical pathways in time, and strengthen the communication with the healthcare security department to give timely feedback on settlement problems. It is necessary to effectively control medical costs and promote the high-quality development of medical institutions and the sound operation of the healthcare security system.

Objective To explore the main influencing factors of fluctuations in medical service prices and to provide references for the government to formulate and dynamically adjust medical service prices. Methods Based on the China Statistical Yearbook from 1998 to 2022, LASSO Regression was applied to select the main influencing factors of medical service prices, and the random forest model was used to rank the relative importance of these factors. Results The LASSO Regression identified eight key variables. The ranking Results of the random forest model showed that the Consumer Price Index(CPI)(0.194), the proportion of personal health expenditure(0.125), the proportion of government health expenditure (0.082), the total dependency ratio(0.079), per capita health expenditure (0.069), the number of participants in basic medical insurance for urban employees (0.062), per capita disposable income of residents(0.056), and the bed occupancy rate(0.052) accounted for 72.63% of the total importance. Conclusions CPI plays a leading role in the fluctuations of medical service prices. The proportion of personal health expenditure, the proportion of government health expenditure, changes in population structure and the utilization efficiency of medical resources have significant impacts on medical service prices.

Through the analysis of the application status of digital intelligence technology in the field of medical services, it is found that digital intelligence technology plays an important role in medical big data analysis, medical image recognition, smart medical management and other aspects, and promotes the rise of new models such as precision medicine, “Internet + healthcare”, and doctor-patient collaborative medical treatment. The advantages of medical service model driven by digital intelligence in improving medical efficiency, optimizing resource allocation, innovating service content, etc., and the challenges in data security, laws and regulations, and personnel training are analyzed and discussed. It is necessary to strengthen top-level design, promote diversified cooperation, strengthen personnel training, accelerate breakthroughs in key technologies, and deepen reform of medicine and healthcare system to promote the development of new models.

The Yangtze River Delta region is one of the regions with the strongest innovation, the highest openness, and the deepest ageing in China. In recent years, the pressure of elderly care has gradually become prominent. The integration of smart elderly care is an important connotation of deep integration and high-quality cooperation in the Yangtze River Delta region. Starting from the current situation of coordinated development of policies and practices of smart elderly care services in three provinces and one municipality of the Yangtze River Delta, this paper finds that smart elderly care services in this region have achieved certain results and have formed certain experiences in resource integration, organizational construction, personnel training and policy coordination through literature retrieval, field research, data analysis, etc. But at the same time, there are also a series of problems such as incomplete investment and cooperation mechanisms, obvious supply-demand structural contradictions, the need to strengthen standardized development, and the lack of a regional integration platform. To address these pain points, it is necessary to further improve the new administrative structure, establish cross-regional and urban and rural coordination mechanisms, strengthen the training of smart elderly care talents, strengthen the industrial chain to improve product quality, and establish an integrated platform and unified service standards, in order to promote the high-quality coordinated development of smart elderly care in the Yangtze River Delta region.

Objective To systematically evaluate the prevalence trends and influencing factors of overweight and obesity among older adults in China from 2008 to 2018, providing a basis for optimizing the prevention and control policies and intervention strategies for obesity among older adults. Methods Based on the data from Chinese Longitudinal Healthy Longevity Survey (CLHLS), 27,363 older adults aged ≥60 years in 2008, 2011, 2014 and 2018 were included, and overweight and obesity were classified by the BMI index. The chi-square test, T-test, ANOVA, and rank sum test were performed by using SPSS 23.0. The binary logistic regression model was applied to identify factors influencing overweight or obesity and its changes. Results The overall overweight prevalence of the subjects increased from 11.84% in 2008 to 25.46% in 2018, and the obesity prevalence rose from 2.82% to 8.49%. The overweight prevalence and obesity prevalence significantly decreased with advancing age, which were higher in urban areas than in rural areas. The overweight Prevalence of women was higher than that of men, and the obesity prevalence of men was higher than that of women. Risk factors influencing overweight or obesity of the subjects included higher living standards (OR=1.178), being married (OR=1.147), chronic diseases (OR=1.740), and a high intake of staple foods (OR=1.236), etc. Protective factors included a light diet (OR=0.838), smoking (OR=0.759), and a high frequency of raising livestock or pets (OR=0.913). Older adults who were married, rarely experienced hunger in childhood, had chronic diseases, consumed vegetables less frequently, drank alcohol and did not smoke were more likely to be overweight or obese. Conclusions The prevalence of overweight and obesity among Chinese older adults showed a year-by-year increase, with notable urban-rural disparities. Factors such as health status, diet and lifestyle behaviors significantly influenced their occurrence.

Objective Based on the Healthy China strategy, this paper systematically reviews the evolution and current configuration of traditional Chinese medicine (TCM) policies to provide an optimized direction and reference path.Methods 52 TCM policies closely related to Healthy China from 2016 to 2024 were collected, whose evolution process was analyzed. Meanwhile, NVivo12 software was used to code and analyze the text content, and a quantitative model was built from three dimensions of policy tools, stakeholders and policy intensity.Results Policy changes were divided into three periods. In the initial stage, a macro strategic plan was established as the foundation. In the middle stage, innovative practices were explored. In the later stage, reforms were driven by social demands, gradually promoting the high-quality development of Healthy China. In the dimension of policy tools, environment-oriented policy tools were the most(41.34%), followed by supply-oriented policy tools (40.08%), and demand-oriented policy instruments had the smallest proportion (18.58%), and there was a shift in focus of the secondary policy instruments. In the dimension of stakeholders, social forces and the pharmaceutical industry have always been in a marginal position. In terms of policy intensity, it was found that policy formulation lacked high-level planning and the overall intensity was relatively weak. In the three-dimensional analysis, there were structural contradictions among policy tools, stakeholders and policy intensity.Conclusions The policy tool system of TCM policies is out of balance; there is imbalance within the policy tools; some stakeholders are marginalized, and the matching of the policy structure is insufficient.

Objective To explore the effect of Diagnosis-Intervention Packet (DIP) on the hospitalization expenses of patients in public hospitals, evaluate the effectiveness of cost control of DIP, and provide references for optimizing medical expense structure and promoting refined management in public hospitals. Methods A total of 2,078,923 information of front page of medical records of discharged patients from a third-class hospital in Henan Province from 2021 to 2023 were collected. By screening the top ten diseases of discharges, 69,934 valid data were obtained. Non-parametric test, grey relational analysis and structural variation were employed to analyze changes of hospitalization expenses. Results After the reform of DIP payment method, the total cost of inpatients and average cost per hospitalization have decreased significantly, and the inspection and laboratory examination fees were the most related to the total cost per hospitalization. The structural variation degree of medical cost of the top ten diseases was 14.32% from 2021 to 2023. The contribution rates of structural variation in descending order were material fees (29.36%), inspection and laboratory examination fees (25.64%), western medicine fees (20.64%), medical service fees (17.49%), traditional Chinese medicine fees (6.81%), and other fees (0.06%). Conclusions The DIP payment method effectively controls hospitalization expenses of patients and plays a guiding role in optimizing the cost structure of public hospitals. Material fees, with a relatively high structural contribution rate, are the main factor affecting the variation of average expenses per hospitalization.

Objective To understand the structural variation of hospitalization costs of patients with coronary artery disease (CAD) under the background of DRG payment reform, analyze the factors and categories affecting the changes in costs, and discuss the internal connection between policies and fee changes, so as to provide a reference for promoting the reform of the medical insurance payment system. Methods The data of 41679 inpatients with CAD in The First Affiliated Hospital of Guangxi Medical University from 2019 to 2023 were analyzed by structural variation degree and new grey relational analysis. The structural variation degree was used to describe the overall situation and the trend of dynamic changes of the composition of hospitalization costs, and new grey relational analysis was used to evaluate the degree of correlation between hospitalization costs and costs of each item. Results From 2019 to 2023, the average hospitalization costs per visit of patients with CAD overall showed a decreasing trend, with an average annual decrease of 5.6%.From 2019 to 2023, the structural variation degree of the average hospitalization costs per visit was 8.59%. The top three contribution rates of structural variation of types of costs were treatment costs (32.9%), drug costs (27.0%) and diagnostic fees (17.1%), and the cumulative contribution rates of the three items were 77%. Among them, the proportion of drug costs decreased year by year, and there was a reverse change between costs of comprehensive medical services and diagnostic fees. Drug costs, costs of comprehensive medical services and other costs (mainly consumables) had the greatest correlation with hospitalization costs. Conclusions The structure of hospitalization costs of patients with CAD has been optimized, with short-term fluctuations due to the epidemic. Drug costs remain the main item in hospitalization costs. Incentives for the value of medical workers are insufficient. The DRG/DIP payment reform and clinical pathways management have shown initial Results, but more efforts are needed.

Objective To understand and analyze the current situation of anxiety of college students and related influencing factors, so as to provide the basis for formulating corresponding interventions. Methods An online questionnaire survey was conducted on 3,086 college students by using Generalized Anxiety Disorder (GAD-7) scale, and chi-square test and multiple logistic regression analysis were used to analyze the influencing factors. Results The detection rate of anxiety was 45.0% among respondents, of which 35.6% were mild; 7.3% were moderate and 2.1% were severe. The results of simple analysis showed that there were statistically significant differences in the distribution of anxiety of college students in six factors: residence, grade, parents' education level, main caregiver, family relationship and family economy (P<0.05). Multiple logistic regression analysis showed that residence (OR=0.849), grade (OR=1.642), family relationship (OR=0.504) and family economy (OR=0.489) were associated with anxiety (P<0.05). Conclusions The anxiety of college students is related to residence, grade, family relationship and family economy. It is necessary to create a positive learning atmosphere on campus and a good family atmosphere, pay attention to the pressure of college students, and help them improve their adaptability.

This paper reasonably delineates the scope of privacy protection in psychological counseling, clarifies the basic norms for exceptions to privacy protection, and establishes a set of complete and practical procedural privacy protection norms to protect the privacy of clients in psychological counseling throughout the whole process. This paper collects and analyzes Chinese and foreign literature, relevant judicial cases, and authoritative and official information, as well as conducts key informant interviews with counselors to understand the current jurisprudential base and rule of law environment. The existing problems are sorted out as follows: At present, the scope of privacy protection in psychological counseling in China is not clear, and methods of protection are inadequate; the rules of protection are too general, and there is a lack of consensus on exceptions to confidentiality; there is a lack of specific norms to protect the privacy of special clients such as high-risk clients, minors and those involved in judicial investigations; and the protection mechanism is imperfect, and there is a lack of protection throughout the whole process. At the same time, the following suggestions are put forward. The boundaries of clients' privacy should be established by law. Basic norms for exceptions to privacy protection should be established, especially for higher-risk clients, minors and criminal suspects in judicial investigations. Procedural privacy protection norms should be established that apply to the whole process.

Objective To analyze the influencing factors of excess hospitalization expenses of patients in urology, and to provide the reference for medical institutions to control overspending and formulate high-quality development policies for hospitals. Methods Taking the cases of overspending in urology of a third-grade hospital in Nanjing as an example, the influencing factors of overspending were analyzed by single factor analysis and structural equation model. Results The effect of robot assistance on excess hospitalization expenses of patients in urology was 0.525. The impact of complications on cost overrun was -0.314. The impact of the number of operations on cost overrun was 0.168. The impact of hospital days on cost overrun was 0.122. The impact of fund types on cost overrun was 0.071. The effect of age on cost overrun was -0.047. Conclusions The use of robot assistance has the greatest impact on the overspending in urology department. The hospital length of stay not only affects the cost overrun, but also positively affects the relationship between other factors and cost overrun. Excess hospitalization expenses of patients in urology without complications are generally higher than that of patients with complications.

This paper reviews the application status and development trend of complex networks in public health in the past 15 years, with emphasis on the theoretical basis of complex networks, social networks, biological networks, human complex networks and the application of complex network analysis technology in the field of public health. Through combing previous studies, it is found that complex networks, as a multidisciplinary research tool, are of great significance in the establishment of disease transmission models, disease control, and the formulation of health policy. However, there are still many challenges in the application of complex networks in public health, such as the lack of interdisciplinary cooperation and the control of complex model parameters. Meanwhile, complex networks have broad application prospects in the field of public health. It is believed that with the continuous improvement of complex network theory, it will provide new perspectives and new methods for solving problems in the field of public health and medical treatment, and promote the progress and development of global public health.

Objective This paper compares Chinese residents' comprehensive evaluation of healthcare system and its influencing factors in 2011 and 2021,and analyzes its changes in the past 10 years, providing empirical evidence for deepening the reform of China's medical and healthcare system and promoting the sustainable development of medical and healthcare system. Methods Based on the data of 2011 and 2021 China General Social Survey (CGSS), a three-dimensional analytical framework for the factors influencing the residents' comprehensive evaluation of the healthcare system, including demographic characteristics, social environment and medical services, was constructed. SPSS and other tools were used to complete the analysis of differences and establish a multivariate linear regression model to analyze the factors influencing the residents' comprehensive evaluation of healthcare system. Results The mean value of comprehensive evaluation of the medical and health system of Chinese residents in 2021 was 3.97, which was higher than that in 2011 (3.50). Recent diagnosis and treatment satisfaction (β=0.311 in 2021, β=0.310 in 2011) and access to quality healthcare (β=0.234 in 2021, β=0.156 in 2011) were the most important factors influencing the residents' comprehensive evaluation of healthcare system. Conclusions Residents' overall evaluation of the medical and healthcare system has been improved over the past 10 years. The quality of medical services and the accessibility of medical resources are the most important concerns in residents' comprehensive evaluation of the healthcare system. The improvement of residents' sense of social justice and trust in the local government help improve their comprehensive evaluation of the healthcare system.

With the rapid development of digital technology, the importance of digital literacy in the field of healthcare has become increasingly prominent. This study explains the concept of digital literacy in the field of healthcare, systematically sorts out its main applications from business scenarios, education scenarios and innovation scenarios, and summarizes the research value. The current situation and trend of research and application of digital literacy in the field of healthcare are analyzed from two dimensions at home and abroad. It is found that those studies focus on competency framework of digital literacy, training platforms of digital literacy, health equity and health promotion. The research puts forward suggestions to further strengthen the application and research of digital literacy from three aspects: to carry out extensive research from specific populations to multiple subjects, to promote the transformation from digital skills to digital literacy, and to accelerate the research process of digital literacy promoting digital health.

This paper takes five DIP demonstration cities of Guangzhou, Dongying, Xiamen, Yichang and Luzhou as examples to sort out the current situation of policy implementation, compare the policy implementation in each overall planning area, and analyze the causes of policy design, implementation effects and existing problems. It is found that there are still some differences in the technical specifications of total budget management, disease groups management, settlement and clearing in each overall planning area. From the perspectives of policy, medical insurance and medical treatment, suggestions are put forward to improve the follow-up supporting policies of overall planning areas, optimize and gradually unify the technical specifications of overall planning areas, improve and give play to the management functions of medical insurance departments at all levels, and strengthen the fine management of medical institutions.

Objective To systematically analyze the burden of disease of HIV/AIDS and prevalence in China from 1990 to 2019, and to provide evidence-based basis for optimizing HIV/AIDS prevention and control strategy in China. Methods The Global Burden of Disease 2019 (GBD 2019) database was used to select the mortality rate, disability-adjusted life years (DALYs), years of life lost (YLL) rate, years of healthy life lost due to disability (YLD) and other indicators of HIV/AIDS in Chinese population from 1990 to 2019. The Joinpoint regression model was used to analyze the trend of each indicator changing with years, gender and age. Origin software was used to make trend charts. Results From 1990 to 2019, the incidence of HIV/AIDS in the Chinese population increased from 0.82 per 100, 000 to 2.24 per 100, 000. The mortality rate increased from 0.23 per 100, 000 to 2.23 per 100, 000. The DALYs increased from 13.18 per 100, 000 to 98.15 per 100, 000. The YLL rate increased from 12.18 per 100, 000 to 92.10 per 100, 000. The YLD increased from 1.01 per 100, 000 to 6.05 per 100, 000. According to Joinpoint regression analysis, the standardized mortality rate, DALYs, YLL rate and YLD showed an overall upward trend, and AAPC was 7.1%, 6.4%, 6.6% and 5.5%, respectively, P<0.05. The burden of disease of HIV/AIDS in Chinese men of all ages was higher than that in women. Young and middle-aged people and elderly people were high-risk groups. Conclusions The burden of disease of AIDS in China has significantly increased over the past 30 years, and AIDS has a prominent impact on men, young adults and the elderly, highlighting the grim situation of AIDS prevention and control.

The current management mechanism of patient-physician communication is a management mechanism based on medical documents, and there are shortcomings of emphasizing entity over procedure. In terms of management methods, document production is the starting point. The lack of substantive control measures in the process of patient-physician communication is an important reason for the defects in patient-physician communication in medical institutions. The management mechanism of patient-physician communication based on legal procedures divides the whole process of patient-physician communication into three modules: communicator, communication content and patients' decision-making, which has certain advantages over the traditional management mechanism based on medical documents. Medical institutions have the conditions for standardized management of the patient-physician communication process. Therefore, medical institutions should change the management modes of patient-physician communication, upgrade from traditional document management to process quality control, and improve the management system of medical communication from the setting of working departments, reasonable personnel allocation, and the formulation of management systems. Management paths such as the optimization of identity identification, process quality control, communication records and third-party witness are used to strengthen the management of patient-physician communication.

Objective To study the impact of DRG payment reform on the operation management of a children's specialized hospital and provide a reference for improving the quality of hospital management.Methods This paper takes a tertiary first-class children's specialized hospital in Shandong Province as the sample, and the first page of medical records, financial data and DRG grouping data of 42 months before and after the implementation of DRG were selected. An interrupted time series model was used to analyze the changes in medical service capacity, quality and efficiency before and after the implementation of DRG payment reform.Results After the implementation of DRG payment reform, CMI increased significantly (β₁+β₃=0.004, P<0.05), while time consumption index (β₁+β₃=-0.001, P<0.05), cost consumption index (β₁+β₃=-0.004, P<0.05) and average cost per visit (β₁+β₃=-32.62, P<0.05) decreased significantly. There was no significant changes in the indicators of medical service quality (15-day readmission rate, mortality rate in the low-risk group, the incidence of hospital infection) (P>0.05).Conclusions The DRG payment reform has effectively improved the medical service capacity and efficiency of children's specialized hospitals.

Objective This paper explores policy effects of medical insurance for urban and rural residents on quality of life of older adults from the aspects of economy, medical care and health indicators, and provides the reference for the follow-up policy adjustment. Methods Based on the five panel data of 2011-2020 China Health and Retirement Longitudinal Study (CHARLS), people over 60 years were selected as the subjects, and a PSM-DID model was built to assess the policy effects of medical insurance for urban and rural residents from three indicators: economy, medical care and health. Results Both regression results and robustness testing indicated that the medical insurance for urban and rural residents increased the expectation of future income, and total income and total consumption increased to varying degrees (0.085, 0.246,P<0.01); the health expenditure of older adults was increased (0.879,P<0.01) to promote the utilization of medical services; self-assessed health of older adults was improved (0.499, P<0.01), and quality of life of older adults was improved to varying degrees. In terms of heterogeneity, medical insurance for urban and rural residents had a positive expected effect on expenditures of low-income seniors (P<0.01), and had a more pronounced effect on the medical indicators of high-income seniors (P<0.01). In terms of health, the policy had a greater impact on the low-income seniors (P<0.01), and women benefited more in terms of medical care and economic income (P<0.01). Conclusions Medical insurance for urban and rural residents can effectively improve quality of life of older adults, including economic, medical and health conditions. At the same time, the policy should be precision targeting to support low-income and other vulnerable groups.

Objective This study provides the basis for optimizing the disease grouping scheme and payment standards of acute myocardial infarction (AMI) by studying the case-mix and the composition of inpatient hospital costs of patients with AMI at a tertiary hospital. Methods Univariate analysis and multiple linear regression were used to analyze the influencing factors of hospitalization costs of 4,288 patients with AMI from a tertiary hospital from January 2019 to December 2023. Variables of classification thresholds were screened out. A case-mix model for Diagnosis Related Groups (DRG) was developed and the cost standards were established by using the decision tree. The effectiveness of the case-mix model was evaluated by coefficient of variation, variance reduction, and Kruskal-Wallis H-Test. Results Length of hospital stay, age, types of hospital admissions, number of surgeries/procedures, number of other diagnoses and number of emergencies were the main factors influencing inpatient costs. The above factors were incorporated into the decision tree model, forming 11 case-mix groups and charging standards, which could explain 83.72% of the actual costs. The patients who exceeded the cost limitations accounted for 6.90%, consuming 8.47% of medical resources. Conclusions DRG of patients with AMI established by decision tree model were reasonable in this study, and the corresponding hospitalization cost standards and disease weights were obtained. Analysis of exceeded costs was carried out for the disease groups to clarify cost components for both within and outside the cost thresholds, which provides a reference for the decision-making of the local healthcare security department and controls the unreasonable growth of medical expenses.

This paper reviews the current development status and mechanism of the digital empowerment in big health industries, and finds that there are problems such as difficulty in ensuring data security, talent shortage coexisting with technical barriers, low user acceptance and participation, and urgent need to improve policies and regulations. Therefore, it puts forward some countermeasures and suggestions, such as strengthening the construction of guarantee mechanisms for data security, increasing personnel training, building user participation and feedback mechanisms, and formulating forward-looking policies and regulations.

With the shortage of medical resources and the trend of international digital development, digital health has begun to develop and be applied in the life cycle management of tumors. Based on the summary of the development and application of digital products for tumor at home and abroad, this paper suggests that focused areas of development are the front-end prevention and screening link, and the middle and back-end rehabilitation management needs to be mature. It is proposed to strengthen top-level design to accelerate the development of digital transformation of tumor management; strengthen multi-departmental cooperation to improve the services level of intelligent management for cancer outside hospitals; provide appropriate digital health services based on patients' needs; strengthen the research and development of intelligent products of cancer outside the hospital, and improve data management and optimization.

Objective This paper hierarchically studies the allocation level and spatial differences of medical and health resources in China from the perspective of hospitals and primary medical and health institutions, so as to provide references for further optimizing the allocation of medical and health resources. Methods Health Resource Density Index and Dagum Gini coefficient were used to calculate the health resource allocation level index, so as to empirically analyze the allocation level and spatial differences of medical and health resources in China. Results From 2013 to 2021, the resource allocation levels of hospitals and primary medical and health institutions in China have increased. Among them, the mean value of health resource allocation level index of hospitals increased from 0.1915 to 0.2936, and that of primary medical and health institutions increased from 0.2810 to 0.3554. In terms of spatial differences, the equity of health resource allocation level in hospitals was west < east < central region, and that in primary medical and health institutions was west < central region < east. Conclusions The overall level of medical and health resource allocation in China has been improved, but the structural rationality is insufficient and there is a significant regional gap. The development strategies should be adjusted according to local conditions to promote the coordinated development of hospitals and primary medical and health institutions in various regions.

Objective A special survey is carried out on weekend outpatient clinics of 22 Beijing municipal tertiary hospitals to understand the current situation and service volume of weekend outpatient clinics, sort out and analyze the difficulties, and put forward optimization strategies for the problems. Methods The registration data of 22 Beijing municipal hospitals from January 1, 2023 to December 31, 2023 were collected. The number of registration, utilization rate and the management of registration in key departments of weekend outpatient clinics and weekday outpatient clinics of each hospital were compared and analyzed. Results The utilization rate of registration of weekend outpatient clinics in 22 Beijing municipal tertiary hospitals ranged from 24.81% to 100.00%. The utilization rates of registration of general outpatient clinics, expert clinics and special outpatient clinics on weekends were higher than that on weekdays. In most of the key departments of municipal hospitals, the utilization rate of registration of weekend outpatient clinics was higher than that of weekday outpatient clinics. Conclusions The demand of patients for weekend clinics is great, especially for the dominant departments of hospitals. All hospitals need to make a reasonable allocation of medical resources and human resources. While saving hospital operating costs and protecting the legitimate rights and interests of medical staff, hospitals should reasonably set the opening time of weekend outpatient clinics and registration numbers of popular departments to meet the needs of different patients.

Objective Through the research on the operational efficiency of public hospitals and influencing factors in J Province, it provides the reference for the scientific and reasonable allocation of medical resources of public hospitals in China. Methods This paper took 297 public hospitals in J Province in 2022 as research objects,and the data of health statistics reports of each hospital were collected, and three input indexes (the number of health technicians, the number of beds, and the number of equipment over 10, 000 yuan) and two output indexes (total number of patients and the number of discharges) were selected for data envelopment analysis (DEA). Tobit regression was used to analyze the influencing factors of hospital efficiency. Results In 2022, the average of comprehensive efficiency of public hospitals in J Province was 0.612; the average of pure technical efficiency was 0.658 and the average of scale efficiency was 0.919. Gross regional product, the permanent population of the region, the ratio of doctors to nurses, total income, the proportion of drugs, and daily consultations of physicians were all factors that affected the operational efficiency of public hospitals. Conclusions The overall operational efficiency of public hospitals in J Province is relatively low, and the scale expansion affects the improvement of operational efficiency. The development of talent and technology is not synchronized with the scale expansion in public hospitals, and the technical efficiency still has room for improvement. Operational efficiency is negatively correlated with the proportion of drugs. The proportion of drugs should be controlled for the sustainable development of the hospital.

Objective To understand the cancer patients' current demand for digital health services in China. Methods A total of 4,375 cancer patients in Shanghai were selected to conduct a survey on the demand for digital health by using multi-stage stratified cluster random sampling. The questionnaire included socio-demographic characteristics, the demand for digital health (SCNS-SF34 and self-reported need for digital health services), ECOG Performance Status, Healthy Sleep Score Scale, a nutrition-screening tool named age, intake, weight and walking (AIWW), and mental status (GAD-2 and PHQ-2). Logistic regression analysis was used to explore the factors influencing the demand for digital health. Results The demand rate of cancer patients for digital health was 55.93% (54.46%-57.40%). The most urgent need was health information. The most widely known and used digital health was intelligent healthcare. The results of multiple factor analysis showed that cancer patients with high number of comorbidities, poor sleep, poor health status rated by ECOG, risk of malnutrition, anxiety and depression symptoms were more likely to have the demand for digital health. Conclusions The government and other multi-parties should provide appropriate digital health services such as developing health literacy skills and platforms for psychological counseling based on the current needs.

This article introduces broad application prospects of ChatGPT-4o in medical data management, assisting clinical decision-making, and promoting the popularization of digital healthcare by virtue of its real-time video conversation capability and exceptional retrieval and generation capabilities. The problems associated with its application are analyzed, such as data breaches, risk of improper handling and risk of human damage caused by intelligent decision-making errors. The following suggestions are put forward. In terms of responsibility after the event, medical personnel, medical institutions and developers of medical artificial intelligence should be required to bear civil liability, administrative liability and criminal liability respectively under certain conditions based on the concepts of joint administration of civil, administrative and criminal laws and multiple subjects. In terms of pre-event risk prevention, it is necessary to build a compliance management mechanism of medical data full lifecycle, system of algorithm interpretation right, and algorithm filing system. Algorithm design, operational logic and potential risks are incorporated into the legal and regulatory framework to comprehensively prevent risks.

Objective To explore the composition and influencing factors of the cost of hospital stays for patients undergoing lung cancer surgery under Diagnosis-Intervention Packet (DIP) payment system, and to provide a scientific basis for the reasonable cost control and fine management of hospitals and medical insurance departments under the DIP. Methods The basic information, information of medical expenses and the front page of medical records of patients who were discharged from a hospital in Hebei Province and whose diagnosis was lung cancer from January 1, 2022 to December 31, 2023 were collected. Multiple linear regression and path analysis were used to study the composition of inpatient hospital costs and its influencing factors. Results The coefficient of variation (CV value) of inpatient hospital costs for each DIP disease score ranged from 0.16 to 0.30. In the composition of the cost of hospital stays for patients with lung cancer, the proportion reflecting medical staff's technical value was 20.08%, and the proportion reflecting medical staff's labor value was 14.07%. The proportions of costs of materials for health (consumables) and drug costs were relatively high, accounting for 40.20% and 21.87% of the total cost of hospital stays respectively. Among the factors influencing inpatient hospital expenses, the direct effect of hospital stays on the inpatient hospital expenses was 0.459. The direct effect of age on inpatient hospital expenses was 0.181, and the indirect effect was 0.117. The direct effect of DIP grouping on inpatient hospital expenses was 0.257, and the indirect effect was 0.099. The direct effect of types of insurance on inpatient hospital expenses was 0.081, and the indirect effect was 0.059. Conclusions There are significant differences in the cost of hospital stays under each DIP disease group. In the composition of the cost of hospital stays, the proportions reflecting the technical value and labor value of medical staff are relatively low, while the proportions of costs of materials for health (consumables) and drug costs are relatively large. Hospital stays, age, DIP grouping, and patients' insurance types directly affect the cost of hospital stays, in which age, DIP grouping and insurance types also have an indirect impact on the total expenses through affecting hospital stays.

Objective To explore the effects of subjective and Objective intergenerational support on the health of the elderly, so as to provide a basis for promoting the health of the elderly. Methods Based on the data of 2020 China Longitudinal Aging Social Survey (CLASS), 9, 155 elderly people were extracted and analyzed by descriptive statistics, chi-square test and binary logistic regression model. Results Equal Objective intergenerational support was conducive to the health of the elderly. Equal intergenerational economic support (OR=0.738, P<0.01), equal intergenerational housework support (OR=0.677,P<0.01) and strong intergenerational emotional support (OR=1.417, P<0.01) were more likely to have good health for the elderly. Balanced subjective intergenerational support was conducive to the health of the elderly. The elderly with balanced subjective intergenerational support (OR=1.234, P<0.01) were more likely to have good health. Conclusions The sense of balance of intergenerational support is the overall feeling of the balance of long-term intergenerational support mobility between the elderly and adult children. In the family, adult children need to pay attention to whether the balance of Objective intergenerational support mobility and the elderly's sense of balance of subjective intergenerational support match.

As an important supplement to China's medical services, free clinic activities have played a positive role in improving the level of primary medical services and alleviating the unequal distribution of medical resources. However, in practice, free clinic activities are faced with the challenges of unified standardization and management, difficult application of existing laws and regulations, and difficult law enforcement of health administrative departments. Through literature research and normative analysis, this paper studies and sorts out the existing legal dilemmas and problems of free clinic activities, and puts forward the countermeasures such as improving the supervision platform, perfecting the legal system and strengthening cross-departmental collaboration, so as to promote the innovation and sustainable development of free clinic activities.

Objective To evaluate the impact of Diagnosis-Intervention Packet (DIP) on resource allocation and medical quality. Methods The interrupted time series analysis (ITS) was employed to assess changes of disease types-related indicators in the performance assessments before and after the implementation of DIP in a tertiary hospital. Results In terms of resource allocation, in the initial phase of the implementation of DIP, the average expenditure per admission and average length of stay for each disease decreased. The average expenditure per admission for acute myocardial infarction and chronic obstructive pulmonary disease decreased by 6053.91 yuan and 4496.22 yuan respectively. The average length of stay for certain disease categories showed a significant upward trend over time (P<0.05). In terms of medical quality, in the initial phase of the implementation of DIP, in-hospital mortality rates of each disease did not increase significantly. The in-hospital mortality rates of some diseases showed a significant upward trend over time (P<0.05). Conclusions DIP initially optimizes resource allocation without compromising medical quality. However, the long-term effect of DIP is not good and it may have certain negative impacts on the control of medical expenses and medical quality, which requires further research.