Objective:To investigate community residents' utilization preferences for "Internet + Nursing Service" and provide evidence for improving service uptake.Methods:Based on literature review, semi-structured interviews, and expert consultation, six service attributes and their levels were identified. Using a discrete choice experiment, 12 choice sets were generated through orthogonal design. Convenience sampling was employed to recruit 294 community residents in Nanjing from January to October 2024. A structured questionnaire was administered, and a conditional logit model was used to explore residents' preferences for "Internet + Nursing Service".Results:A total of 294 questionnaires were distributed, and all were validly returned, with an effective response rate of 100.0%. Preference analysis revealed that nurse type, service continuity, hospital classification, medical insurance coverage, and service price significantly influenced residents' preferences for "Internet + Nursing Service" ( P<0.05). Relative importance analysis indicated that the most valued attributes, in descending order, were medical insurance coverage (41.7%), nurse type (17.9%), service price (12.7%), hospital classification (12.1%), service continuity (11.7%), and waiting time (3.9%). When the proportion of medical insurance coverage reached 80%, residents' willingness to pay was the strongest. Conclusions:Medical insurance coverage is the key factor affecting community residents' choice of "Internet + Nursing Service". Residents prefer services provided by general hospitals and expert nurses. It is recommended to improve medical insurance and pricing policies, allocate resources precisely, and enhance service quality to promote the development of "Internet + Nursing Service".

Objective:To investigate community residents' utilization preferences for "Internet + Nursing Service" and provide evidence for improving service uptake.Methods:Based on literature review, semi-structured interviews, and expert consultation, six service attributes and their levels were identified. Using a discrete choice experiment, 12 choice sets were generated through orthogonal design. Convenience sampling was employed to recruit 294 community residents in Nanjing from January to October 2024. A structured questionnaire was administered, and a conditional logit model was used to explore residents' preferences for "Internet + Nursing Service".Results:A total of 294 questionnaires were distributed, and all were validly returned, with an effective response rate of 100.0%. Preference analysis revealed that nurse type, service continuity, hospital classification, medical insurance coverage, and service price significantly influenced residents' preferences for "Internet + Nursing Service" ( P<0.05). Relative importance analysis indicated that the most valued attributes, in descending order, were medical insurance coverage (41.7%), nurse type (17.9%), service price (12.7%), hospital classification (12.1%), service continuity (11.7%), and waiting time (3.9%). When the proportion of medical insurance coverage reached 80%, residents' willingness to pay was the strongest. Conclusions:Medical insurance coverage is the key factor affecting community residents' choice of "Internet + Nursing Service". Residents prefer services provided by general hospitals and expert nurses. It is recommended to improve medical insurance and pricing policies, allocate resources precisely, and enhance service quality to promote the development of "Internet + Nursing Service".

Objective Under the background of DIP payment reform,the data quality of medical record home pages has become a core factor affecting the efficiency of hospital medical insurance settlement and economic benefits.Methods This study aimed to address the issues in the completion of medical record home pages by residents in tertiary hospitals and constructed an improvement system based on the Six Sigma method and RBRVS.Results In 2023,the defect rate of medical record home pages was 5.97％,with major defects concentrated in the names of surgical procedures(19.9％)and the filling of primary diag-noses(18.15％).By establishing a closed-loop management scheme under the"structure-process-outcome"theoretical frame-work-including standardized entry processes,a"three-medical linkage"supervision mechanism,and an RBRVS-based perform-ance appraisal system-the error rate of medical record home pages dropped to 2.04％in 2024 after applying Six Sigma improve-ments.Conclusion The RBRVS performance indicators,through differentiated weight design,can motivate physicians'initia-tive and improve the data quality of medical record home pages,thereby achieving accurate medical insurance settlement.It is recommended to explore intelligent verification paths combined with AI technology in the future to achieve synergistic optimization of medical record quality and hospital operations.

Objective Under the background of DIP payment reform,the data quality of medical record home pages has become a core factor affecting the efficiency of hospital medical insurance settlement and economic benefits.Methods This study aimed to address the issues in the completion of medical record home pages by residents in tertiary hospitals and constructed an improvement system based on the Six Sigma method and RBRVS.Results In 2023,the defect rate of medical record home pages was 5.97％,with major defects concentrated in the names of surgical procedures(19.9％)and the filling of primary diag-noses(18.15％).By establishing a closed-loop management scheme under the"structure-process-outcome"theoretical frame-work-including standardized entry processes,a"three-medical linkage"supervision mechanism,and an RBRVS-based perform-ance appraisal system-the error rate of medical record home pages dropped to 2.04％in 2024 after applying Six Sigma improve-ments.Conclusion The RBRVS performance indicators,through differentiated weight design,can motivate physicians'initia-tive and improve the data quality of medical record home pages,thereby achieving accurate medical insurance settlement.It is recommended to explore intelligent verification paths combined with AI technology in the future to achieve synergistic optimization of medical record quality and hospital operations.

Objective:To analyze the influencing factors of patient loyalty in internet diagnosis and treatment, for references for improving the service quality and promoting the sustainable development of internet diagnosis and treatment.Methods:In November 2023, a simple random sampling method was used to select patients who had received internet diagnosis and treatment as the survey objects and conduct a questionnaire survey on performance expectations, effort expectations, social influence, promotion conditions, price values, patient trust and patient loyalty. By establishing an unified theory of acceptance and use of technology model of influencing factors of patient loyalty in internet diagnosis and treatment, the hypotheses were put forward. The structural equation model (SEM) test and mediation effect test were used to verify the hypothesis path and variable mediation effect, and explore the influencing factors of internet patient loyalty.Results:A total of 1 800 patients were included in this study, including 1 188 patients(66.0%) who received internet diagnosis and treatment≥3 times/month. According to the SEA test, performance expectations ( β=0.296, P<0.001), social influence ( β=0.146, P=0.014), promotion conditions ( β=0.366, P<0.001), price values ( β=0.452, P=0.017), and patient trust ( β=0.459, P<0.001) had a direct positive impact on patient loyalty; Social influence ( β=0.147, P<0.001) and promotion conditions ( β=0.084, P<0.001) had a direct positive impact on patient trust. According to the mediation effect test, patient trust partially mediated the relationship between social influence and patient loyalty ( β=0.071, P=0.018), as well as the relationship between promoting conditions and patient loyalty ( β=0.748, P=0.041). Conclusions:Performance expectations, social influence, promotion conditions, price values, and patient trust had a positive impact on patient loyalty, among which social influence and promotion conditions could enhance patient loyalty by strengthening patient trust. It was suggested that relevant institutions should focus on the service quality of internet diagnosis and treatment, further improve performance expectations, expand social impact, improve promotion conditions and regulate price values, so as to enhance the patient loyalty, promote the wide application and rapid development of internet diagnosis and treatment.

Objective:To explore the influencing factors of patients′ preference for internet medical services and provide references for promoting the development of the service.Methods:From June to July 2023, based on the technology acceptance model and the theory of planned behavior, this study constructed the influencing factor model and its hypothetical path of patients′ preference for using internet medical services (platform, content, method and cost). The stratified sampling method was used to select patients from hospitals in Changzhou city, Yangzhou city and Lianyungang city to conduct a questionnaire survey. The survey contents included the personal basic information questionnaire, the patient preference scales and the influencing factors scales for patient preference for internet medical service utilization. Based on the survey results, structural equation model and mediation analysis were used to test the hypothesis path of the model.Results:A total of 1 961 patients were included in this study. The results of structural equation modeling showed that patients′ behavioral attitudes towards internet medical services affect their preferences for service platforms ( β=0.291), content ( β=0.286), mode ( β=0.275) and cost ( β=0.880), subjective norms affect their preferences for service modes ( β=0.206); perceptual behavior control affects their preferences for service modes ( β=0.109) and cost ( β=0.263). Perceived usefulness played a promoting role in the influence pathways of behavioral attitude on platform ( β=0.473), subjective norm on approach ( β=0.543), and self-evaluation of health status on preference for cost ( β=0.414). Perceived ease of use played a promoting role in the influence pathways of perceived behavioral control on preference for cost ( β=0.301)and age on content ( β=0.215). Conclusions:Behavioral attitudes, subjective norms and perceived behavioral control synergistically affect patients′ preference for internet medical service utilization, among which perceived usefulness and perceived ease of use played a partial mediating role. In the future, internet medical development should optimize the operation of internet medical platform and encourage patients to take the initiative to seek medical treatment; accurately locate patients′ medical needs and improve the internet medical service price system; utilize the radiating and driving role of social relationships to optimize the digital medical recommendation model.

Objective:To explore the influencing factors of patients′ preference for internet medical services and provide references for promoting the development of the service.Methods:From June to July 2023, based on the technology acceptance model and the theory of planned behavior, this study constructed the influencing factor model and its hypothetical path of patients′ preference for using internet medical services (platform, content, method and cost). The stratified sampling method was used to select patients from hospitals in Changzhou city, Yangzhou city and Lianyungang city to conduct a questionnaire survey. The survey contents included the personal basic information questionnaire, the patient preference scales and the influencing factors scales for patient preference for internet medical service utilization. Based on the survey results, structural equation model and mediation analysis were used to test the hypothesis path of the model.Results:A total of 1 961 patients were included in this study. The results of structural equation modeling showed that patients′ behavioral attitudes towards internet medical services affect their preferences for service platforms ( β=0.291), content ( β=0.286), mode ( β=0.275) and cost ( β=0.880), subjective norms affect their preferences for service modes ( β=0.206); perceptual behavior control affects their preferences for service modes ( β=0.109) and cost ( β=0.263). Perceived usefulness played a promoting role in the influence pathways of behavioral attitude on platform ( β=0.473), subjective norm on approach ( β=0.543), and self-evaluation of health status on preference for cost ( β=0.414). Perceived ease of use played a promoting role in the influence pathways of perceived behavioral control on preference for cost ( β=0.301)and age on content ( β=0.215). Conclusions:Behavioral attitudes, subjective norms and perceived behavioral control synergistically affect patients′ preference for internet medical service utilization, among which perceived usefulness and perceived ease of use played a partial mediating role. In the future, internet medical development should optimize the operation of internet medical platform and encourage patients to take the initiative to seek medical treatment; accurately locate patients′ medical needs and improve the internet medical service price system; utilize the radiating and driving role of social relationships to optimize the digital medical recommendation model.

Objective:To investigate the current situation and analyze the influencing factors of job satisfaction of infectious disease physicians in Jiangsu Province.Methods:From April to May 2021, a stratified random sampling method was used to select 10 municipal level infectious disease hospitals in Jiangsu province. An electronic questionnaire survey was conducted on the infectious disease physicians of these hospitals using an online questionnaire platform. The questionnaire mainly included the job satisfaction scale developed by Greenhaus and Wormley, and a self-designed job satisfaction influencing factor scale based on resource conservation theory. At the same time, semi-structured interviews were made with relevant insiders on such issues as salary and benefits, and career development among others. Descriptive analysis was conducted on the questionnaire data, while single factor analysis and multiple linear regression analysis were used to identify the factors that affect their job satisfaction, and the results of the interviews were studied with Colaizzi 7-step analysis.Results:A total of 457 valid questionnaires were recovered. The job satisfaction score of infectious disease physicians was (3.38±0.76). The results of univariate analysis showed significant differences in job satisfaction scores among infectious disease physicians of different ages, educational backgrounds, professional titles, and positions. The results of multiple linear regression analysis showed that salary and benefits ( B=0.141, P<0.001), work environment ( B=0.128, P<0.001), leadership support ( B=0.112, P=0.014), development security ( B=0.117, P<0.001), self-efficacy ( B=0.084, P=0.045) and social support ( B=0.285, P<0.001) were both influencing factors of their job satisfaction. The interview results identified such problems as low salary, insufficient salary security, large gap in social security levels between in-staff and off-staff physicians, and insufficient career development potential. Conclusions:The job satisfaction of infectious disease physicians in Jiangsu Province was found at an average level. It is recommended that the government increase the investment in personnel expenses for infectious disease physicians, optimize the salary and benefits structure, pay attention to the career development needs of middle-aged and young physicians, and care about the social relationship needs of infectious disease physicians to improve their job satisfaction.

Objective:To understand the incidence of esophageal cancer in population at high risk in Yangzhong of Jiangsu province.Methods:Cluster random sampling method was conducted to select several natural villages from the high risk area of esophageal cancer in Yangzhong during 2011-2017. Local residents aged 40-69 years were selected as the target population and a total of 14 687 persons were diagnosed esophageal cancer by endoscopy and pathology.Results:Precancerous lesions were detected in 341 persons, with the detection rate as 2.32 % (341/14 687). Among them, there were 234 (1.59 %) cases with mild and 107 (0.73 %) cases with moderate esophageal hyperplasia. There were 77 positive cases with esophageal hyperplasia and the detection rate was 0.52 %. Among these positive cases, 41 showed severe esophageal hyperplasia/carcinoma in situ (0.28 %), with another 19 as early esophageal cancer (0.13 %) and 17 with invasive carcinoma (0.12 %). The overall early detection rate of positivity through active screening was 77.92 % (60/77), with trends of upwarding and then downwarding. The detection rate of esophageal lesions in men was higher than that in women ( P<0.05), but without significant gender specific differences seen in the detection rates of early esophageal cancer or invasive carcinoma ( P>0.05). The detection rates of all lesions other than invasive carcinoma, gradually increased with age ( P<0.05). The detection rate of invasive carcinoma reached the highest (0.39 %, 10/2 547) in the age group of 60-years and slightly decreased in the age group of 65-years old. Conclusions:Considerable numbers of patients with cancer and precancerous lesions in groups at high-risk can be found through the screening program for esophageal cancer, suggesting that the screening program is of great significance in improving the survival rate and quality of life. Attention should be paid to men, with elderly groups in particular, at high-risk in order to increase the detection rate of early cases.

Objective: To evaluate the effectiveness and benefit of the upper gastrointestinal cancer screening in Yangzhong city, Jiangsu province, from 2009 to 2015. Methods: From 2009 to 2015, 31 natural villages with high-incidence of upper gastrointestinal cancer were selected from Baqiao town, Youfang town and Xinglong sub-district in Yangzhong city. 13 776 residents aged 40 to 69 years old were recruited and screened for upper gastrointestinal cancer by using endoscopic examination and pathological diagnosis. Two economic evaluation methods, cost-effectiveness analysis and cost-benefit analysis, were performed to evaluate the current screening schemes. Results: The mean age of all respondents were (53.60±8.14) years old and the males accounted for 43.64% (6 012). A total of 502 cases of upper gastrointestinal tract lesions were detected, including 100 cases of cancer (62 cases of esophagus, gastric/cardiac early stage cancer, 38 cases of advanced stage cancer), 38 cases of severe esophageal hyperplasia/carcinoma in situ, and 15 cases of high-grade intraepithelial neoplasia in stomach/cardia, the detection rate was 0.73%, 0.28% and 0.11%, respectively; the early diagnosis rate was 75.16% (115/153). The cost of a precancerous lesion, a case diagnosed at the early stage and a positive case identified through the upper gastrointestinal cancer screening in Yangzhong City was 10 037.17, 30 460.64 and 22 895.25 RMB, respectively. The early detection cost index from 2009 to 2015 was 0.52, 0.56, 0.48, 0.48, 0.21, 0.30, and 0.26, respectively. The effectiveness-cost ratio from 2009 to 2015 was 3.41, 2.77, 2.66, 2.58, 4.99, 3.12, and 3.48, respectively. Conclusions The project of early diagnosis and treatment of upper gastrointestinal tract cancer in Yangzhong city has achieved good results and benefits.