Purpose/Significance To alleviate digital health technology anxiety in elderly patients with chronic diseases.Method/Process A convenience sampling method is used to survey 1 222 elderly patients with chronic diseases in tertiary,secondary,and commu-nity hospitals in Shanghai,China,with respect to demographic information,the level of anxiety about digital health technologies,and the conditions of individual use of digital health technologies.Logistic regression analyse is used to investigate the factors influencing anxiety in the use of digital health technologies among elderly patients with chronic diseases.Result/Conclusion Elderly patients with chronic diseases as a whole have low moderate levels of anxiety about digital health technologies.Educational level,per capita monthly income,experience of using digital health technologies,and learning ability are independent factors affecting anxiety about digital health technolo-gies among elderly patients with chronic diseases.Aging-friendly design,assistance and support,improved facility accessibility,and precise training should be implemented so as to increase the acceptance and use of digital health technologies among elderly chronic dis-ease patients.

ObjectiveTo investigate the value of remote consultation of heart sound acquisition in screening and referral of neonates with congenital heart diseases （CHD） in primary hospitals. MethodsA total of 4 030 neonates with non-critical diseases were selected. They were born in Shanghai Pudong New Area Maternal and Child Health Hospital from November 5， 2019 to March 31， 2021. After birth， routine cardiac auscultation was performed and remote consultation of heart sound collection were performed at the same time in combination with percutaneous oxygen saturation measurement to screen CHD. The children with any positive screening index were advised to verify the diagnosis by cardiac ultrasound examination in Shanghai Children's Medical Center. The diagnostic value of different screening methods was compared. ResultsA total of 110 cases were detected positive by routine screening. Among them， 16 cases were lost to follow-up， and 46 cases were confirmed by cardiac ultrasound examination， with a positive diagnosis rate of 48.94% （46/94）. A total of 51 cases were detected positive by routine screening and remote consultation of heart sound collection simultaneously. Among them， 42 cases were confirmed by cardiac ultrasound examination， with a positive diagnosis rate of 82.35% （42/51）. The difference between the two positive diagnosis rates was statistically significant （P<0.001）. ConclusionRemote consultation of heart sound acquisition on the basis of routine neonatal CHD screening can effectively improve the positive diagnosis rate of CHD screening in primary hospitals， and reduce unnecessary referrals. This method is simple and feasible. It has practical value in primary hospitals that lack professional technicians for the diagnosis and treatment of CHD.

Since December 2019, an outbreak of novel coronavirus pneumonia (COVID-19) in Wuhan, Hubei Province, which has caused wide public concern all through the world. Although artificial intelligence is a priority development fields in recent years, there is no study on the application and effect of AI in this epidemic. Based on the application of AI scenarios in typical cases, the research analyzes the practice and effectiveness of AI in epidemic surveillance, clinical diagnose, public health management and other related scientific research. Besides, combined with the current situation of development, some suggestions are put forward in order to better play the role of artificial intelligence in the public health emergency system in China.

Objective To evaluated the effectiveness and influence of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes. Methods The large-sample prospective study recruited 1359 eligible adult patients who were residents and had health record from three community health centers of Shanghai Jiading District. The method of randomized complete block design was used to classify the subjects into 4 groups. The physicians incentive group included 337 subjects, while the patients incentive group 338 subjects, the physicians and patients incentive group 331 subjects, the control group which the physicians and the patients would not have the incentive 353 subjects respectively. We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management system was used to carry out the tele-medicine. The type 2 diabetes mellitus patients, which were set goal in blood glucose and blood pressure control, managed by the general practitioners, the daily health behavior of the patients were regulated. All subjects in the patients incentive groups received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 2-years study period. The control group would not receive any incentives but would be provided with diabetes education booklet and group educational courses for diabetes mellitus control as usual. Results After 12 months and 24 months, HbA1C , systolic blood pressure, diastolic blood pressure, total cholesterol, fasting blood glucose in the four groups were all lower than baseline levels (P<0. 05), while the time of related exercise parameters and the rate of HbA1C achieving target in the study groups were higher than baseline (P<0. 05). Besides, the time of related exercise, time of moderate exercise intensity, time of strenuous exercise intensity, and the rate of HbA1C achieving target ( after 24 months:49. 0％, 53. 2％, 51. 8％, 54. 4％, P<0. 05 ) had statistical significance among the physicians incentive, the patients incentive, the physicians and patients incentive, and the control groups. Logistic regression analysis showed that the duration of diabetes, the baseline HbA1C , whether using the insulin, taking hypoglycemic drugs are the main factors of the study with statistical significance (all P<0. 05). Conclusions Based on general practitioners-specialist cooperation tele-medicine, by regulating the daily health behavior and using the intervention of pay for performance, the new diabetes care model could improve the treatment effect of type 2 diabetes to some extent, especially the exercise time and its intensity. Besides, the duration of diabetes, the baseline of HbA1C , the using of insulin and hypoglycemic drugs turned out to be the main factors of the study.

Objective To learn the present hospital medical quality management,to explore and improve the quality of care management system.Methods Literature review analysis theory of medical quality management system,questionnaires analysis the present medical quality management,case and influencing factors.Results The literature review showed that the trend of quality management study increased year by year in recent 20 years,and is gradually becoming a hot topic in China.The management practices survey found the quality of care management systems mostly established,yet with rooms of improvement for the management content and details.Thanks to the three-stage introduction,operation and indepth study of international standards,hospitals have effectively promoted their quality management.Conclusions Key influencing factors for hospital quality management are the design of such quality management system itself,and lack of quality tools and resources.To build a better quality of care management system,efforts should be paid from both internal and external aspects,thus elevating such quality to a new level.

Objective To evaluate the necessity and practicability of optimizing the management of type 2 diabetes mellitus in community after acquiring the peer education and the music therapy to their physical and mental issues and sleep problems. Methods Totally 179 type 2 diabetes mellitus patients who were followed up in Ruijin 2nd community health service center, the random numbers table used to randomize the patients into 2 groups:control group ( 97 cases) and experiment group ( 96 cases), the conventional treatment was used in control group. Besides the conventional treatment measures, the peer support was used by patients in the experiment group. In the second step, 45 patients were met the inclusion and the exclusion criteria, the random numbers table used to randomize the patients into 2 groups:the multiple intervention group (22 cases) and the conventional treatment group (23 cases), the multiple intervention included the music therapy, the peer support and the sleep health education, the conventional treatment included the conventional treatment and the sleep health education. The t test was used to compare the patient's HbA1c and other quantitative data in two groups of patients after the intervention. Results In the first stage of research, compared with the control group patients, the patients 'HbA1c in intervention group was significantly improvement after 6 months(7.26%±1.37%vs.7.53%±1.63%,t=2.148, P<0.05),besides, the intervention group individuals achieved significant improvement in diabetic self-management behaviors and self-efficacy after 6 months, and the improvement in self-efficacy of peer support group was significant different compared with routinely educated patients(104.09±16.40 vs.110.96± 13.86,t=2.120,P<0.05), and the PHQ-9(5.95 ± 4.02 vs.2.55 ± 1.67,t=2.630,P<0.05)between the two group had significant difference, while no improvement was found in PSQI, BMI, and WHR between intervention group and control group. Conclusions Peer support could improve the blood glucose metabolism in patients with type 2 diabetes. With the effect of yoga music and physical exercises, peer support can improve the quality of sleep and decrease depression in T2DM patients, who also have sleep disorders and mild depression.

Objective To learn the present hospital management conditions in Shanghai for upgrading quality of care.Methods The stratified sampling method was used for a questionnaire survey of the quality of care at 20 hospitals in Shanghai (10 tertiary hospitals and 10 secondary hospitals).The survey covered such six dimensions as organizational framework,management functions,management tools,professional training,regulations and norms,and supervision over operations.Results Medical quality management system is established at such hospitals and all of them have established medical quality management committees.Rooms of improvement remain in such details as departmental quality management,regulations standardization,IT support,and management tools popularity.Conclusion Management regulations and standards of medical quality management should be improved and implemented from both external and internal aspects,to improve medical quality and patient safety.

Objective To evaluate a model of management for chronic pain disease coordinated community health services and district hospital. Methods The epidemiology of chronic pain disease was surveyed in Haotao community of Zhongshan, before and after the establishment of the model of management. Results The prevalence rate of chronic pain disease was 51.83%, in which it was 47.06% in men, and 57.32% in women. After the establishment of the model, the efficacy of good to excellent improved from 30.22% to 67.08%, the cost for medicine reduced 36.16%, time for rest reduced from 32.42 d to 15.25 d (P<0.05). Conclusion The model of management that coordinated community health services and district hospital, including demonstration diagnosis and treatment through internet, tele-consultations and health education, is effective on chronic pain disease.

Objective An attempt to develop a patient survey questionnaire on the public benefit nature of medical institutions as seen by patients,along with an evaluation of its reliability and validity.Methods A field survey was conducted among the patients visiting these institutions.The Cronbach's α coefficient was calculated to test the reliability.Factor analysis and spearman correlation analysis were applied to test the validity.The validity was also tested by analyzing the demographic factors and comparing the results between different kinds of medical institutions.Results The Cronbach's α coefficient of the questionnaire was 0.853,meanwhile the Cronbach's α coefficient of the three items was 0.845(quality of care),0.845 (suitability of services) and 0.752 (professional ethics).Three common factors were extracted,which coincided with the three items-quality of care,suitability of services and professional ethics.And the results are hardly affected by common demographic characteristics.Condusion The reliability of the questionnaire was acceptable,and the items were reasonably divided in the questionnaire with good structural validity.The questionnaire can be widely applied to evaluate the public benefit nature of medical institutions.

ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.