In the context of continuously deepening medical and health system reforms and comprehensively promoting the "Healthy China" strategy, Henan Provincial People's Hospital has established a regional collaborative and vertically integrated critical care service structure and network. This initiative aims to enhance information empowerment, strengthen regional collaboration, improve the insufficient primary medical services, and ensure timely and effective treatment for critically ill patients. By establishing a comprehensive dispatch service platform for regional collaborative critical care, building a "top-down" remote medical collaboration network, and forming a cross-regional specialty alliance for critical care, the hospital has improved the efficiency of medical services and enhanced regional capabilities for treating critically ill patients. Simultaneously, for critically serious patients and those with complex diseases at primary medical institutions, a one-stop consultation and referral service has been implemented. This service adopts a "three specialists" approach and a multidisciplinary consultation mechanism within the hospital, constructs a multi-dimensional critical care transfer mode integrating air, ground, and the internet, creates a regional collaborative rescue mode, and implements full-cycle treatment for critically serious patients. The comprehensive, flexible, and efficient service pathway for regional collaborative critical care established by this system ensures timely and safe treatment for critically ill patients, promotes the distribution of high-quality medical resources, and effectively addresses issues such as uneven distribution of high-quality medical resources and varying levels of critical care capabilities. It has facilitated the formation of a new tiered diagnosis and treatment order characterized by "first diagnosis at the primary level, two-way referral, separate treatment for acute and chronic diseases, and vertical integration". This approach has enhanced the diagnostic and comprehensive service capabilities of primary medical institutions. Currently, by strengthening information empowerment and sharing, creating a full-process critical care diagnosis and treatment model, providing medical assistance and cultivating primary-level critical care talent, and promoting appropriate technologies, the hospital has gradually overcome challenges such as barriers to information exchange and sharing between hospitals, overloaded critical care teams, high pressure on patient reception and transfer, and limited critical care capabilities at primary medical institutions. This article summarizes the construction and practical application of this regionally coordinated critical care system, aiming to provide a reference for the management of critical care treatment.
Humans ; China ; Critical Care/organization & administration* ; Delivery of Health Care/organization & administration*

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.