Introduction to the theory of research hospitals (series 4): medical model of the research hospital
Review Article

Introduction to the theory of research hospitals (series 4): medical model of the research hospital

Jun Yao1, Tian Gao2

1Chinese Research Hospital Association, Beijing 100039, China; 2Department of Performance Management, Jinan Central Hospital Affiliated with Shandong University, Jinan 250013, China

Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Jun Yao. Chinese Research Hospital Association, Beijing 100039, China. Email: m18611717182@163.com.

Abstract: With the acceleration of the process of industrialization, urbanization and aging, the incidence of chronic diseases in China is also rapidly rising. According to data from the department of disease control and prevention of the Ministry of Health of China in 2012, China has more than 260,000,000 people diagnosed with chronic diseases. In view of this situation, Chinese hospitals are in a new era, and especially the medical model of research hospitals needs to be changed. It should not only cure diseases, but also participate in the prevention of diseases and take the initiative to assume the dual functions of disease management and health management.

Keywords: Medical model; research hospital; hospital


Received: 04 August 2016; Accepted: 06 September 2016; Published: 25 October 2016.

doi: 10.21037/jrh.2016.09.03


The new mission of research hospitals—health and disease management

Health management

The concept of health management is the concrete manifestation in the new era of the concept that “the best measure is to treat the disease before it happens” of traditional Chinese medicine (TCM) and the “prevention oriented” concept which appeared after the establishment of new China. It is a collective innovation that mainly based on management, economics, sociology, evidence-based medicine and preventive medicine. Health management is a process of comprehensive management of health risk factors for individuals and groups.

Disease management

Disease management is one of the main strategies for health management. It takes different measures to provide different services according to the different stages of the disease, that is, the general sense of the “full process management”. Here the disease management we refer to is the management of the disease of discharged patients, that is, continued intervention on the condition of discharged patients.

Health management and disease management is a new function of research hospitals

For a long time, the hospitals in China have been keen on the diagnosis and treatment of difficult and complicated diseases. As a result, preventive health, health education, disease management and other functions of hospitals have been severely weakened. With the deepening of medical reform in China, research hospitals should innovate their service mode to take the initiative to assume the functions of disease management and health management. In the face of the severe situation of the “blowout type” outbreak of chronic diseases, research hospitals should bear the responsibility and the new historical mission.

Health management service model

According to the characteristics of the development of chronic diseases, the vast majority of the population is not yet suffering from chronic diseases but with high risk factors for chronic diseases; or it does not have the risk factors, but it has unhealthy behaviors. If we provide health management services for such a large population, it cannot only promote the health of people, but also reduce the use of health care resources and reduce the cost of health care. Hence, the research hospital should not only cure diseases, but also carry out research on health medicine and the research and application of the health management service mode.

A specific practice is to convert health examination centers into health management centers to extend the function of traditional health examination centers. It screens out people with high risk factors of life style through the health examination and questionnaire survey and provides them with a personal lifestyle intervention program (exercise, diet, psychological and other means) and a follow-up plan. Also it will carry out tracking management of the screening-out of the high risk population for all kinds of chronic diseases to prevent and stop the development of lifestyle diseases.

Another specific practice is to establish a “research hospital-community vertical integration health management model”. In this model, the research hospital focuses on the research of the health management service mode to summarize the standardized, effective service mode and tools, and provides training and long term business guidance to the community doctors to achieve the health management services covering the area residents provided by the community health service centers. At the same time, it will establish a hierarchical collaborative management mechanism between the research hospital and the community.

Disease management service model

Most of the chronic diseases are lifelong diseases, the treatment in the hospital is far from enough for them. For patients with chronic diseases caused by a bad life style, the disease management requires the duty doctor not only to give the medicine treatment to them, but also to correct their bad life styles; in addition to prescribing drugs, but also to develop a comprehensive adjustment method for them including dietary prescription, exercise prescription, decompression and adjustment, sleep regulation, etc., and to conduct effective supervision to help them change the bad lifestyle to achieve the goal of consolidating the treatment effect of the disease and preventing the recurrence of the disease.


The basic function of the research hospital—clinical diagnosis and treatment

The fundamental purpose of building research hospitals is to improve the level of clinical diagnosis and treatment, and medical care, to make the research hospital become the diagnosis and treatment base of high risk, difficult and complicated diseases. This should be the basic strategic focus of building research hospitals.

Medical diagnosis and treatment model of research hospitals

The medical model of research hospitals includes evidence based medicine, integration medicine, Nano-Bio-Info-Cogno (NBIC) medicine and translational medicine. The translational medicine that takes the close combination of biomedical basic research and clinical application as the core is the key to the transformation of medical diagnosis and treatment of research hospitals. In the process of building the research hospital, the management should take the research medicine diagnosis and treatment model as the main line, scientifically introduce other advanced diagnosis and treatment model ideas, and integrate the advantages of each diagnosis and treatment model, so that they can complement each other, and thus more effectively promote the development of research hospital building.

Science and technology innovation and the improvement of clinical level

Science and technology innovation includes technological innovation and knowledge innovation. Technological innovation is the process of applying new technology to clinical practices in order to obtain the maximum social benefits and economic benefits. Based on the practice, knowledge innovation is to update and develop the existing theory to make it better serve the clinical medical practice. Whether it is technological innovation or knowledge innovation, it is closely related to the development of modern medicine.

Research hospitals need to pay special attention to the following issues in management: to be good at finding the problem with scientific value in clinical diagnosis and treatment to promote scientific and technology innovation through breaking the thinking formula; to create the conditions to transform the scientific and technology innovation into the results of promoting the progress of clinical diagnosis and treatment to improve the level of medical technology.

Translational medicine and the improvement of clinical ability

The core of translational medicine is to break the barriers between basic medicine, clinical medicine and drug research and development, and establish an effective link between basic science researchers and doctors who understand the needs of patients. Especially, it focuses on the transformation from basic molecular biology research to the most effective disease diagnosis, treatment and prevention models to improve the medical level. The most obvious characteristic is to focus on the specific disease, that is, to take human health as the basis, take major diseases as the starting point of research, and take promoting scientific discovery into medical practice as the goal. Research hospitals should pay more attention to the establishment of a clinical platform for translational medicine, to cultivate the talents of clinical medicine, and to establish a clinical biological sample database.

Integration medicine and clinical diagnosis and treatment effect

At present, the clinical division is finer and finer, the doctor’s overall concept is weaker and weaker, which leads to the situation that a specialist in a specialty is very unfamiliar with the diseases in other specialties. This does not contribute to the patient’s comprehensive treatment. The concept of integration medicine can solve this problem.

Integration medicine is to organically integrate the most advanced knowledge theory and the most effective practical experience of each clinical specialty respectively, and to improve it to make it become a new medical system that is more suitable for human health and disease treatment according to the reality of society, environment and psychology. This is completely consistent with the basic characteristics of the diagnosis model of the research hospital.

The development of integration medicine needs to promote the integration of medical disciplines, the integration of clinical medicine, preventive medicine and public health, the integration of health care services and national health promotion, the integration of medical education and health care services, and the integration of medical humanities and medical science.

Evidence-based medicine and the clinical diagnosis and treatment pathway

Evidence-based medicine, as one of the diagnosis and treatment models of the research hospital, is a kind of rational medicine which is different from the traditional empirical medicine. In clinical practice, the implementation of the concept of evidence-based medicine has constructed a model that can integrate evidence and rapidly disseminate the evidence to clinical applications. This model suggests five steps in the practical process of clinical medicine: putting forward the problem needed to be solved; searching relevant evidence; evaluating evidence; applying evidence; and evaluating effect. Through these five steps, clinicians can quickly transform the research results to the clinical diagnosis and treatment process, which shortens the time of applying the research results to the clinical practice, and greatly improves standardization and rationality of medical decision-making.

From the definition of evidence-based medicine and clinical implementation steps, it can be seen that the implementation of the concept of evidence-based medicine is an essential process for the practice of the translational medicine model. Evidence-based medicine in clinical practice can significantly improve the medical quality indicators and make the clinical diagnosis and treatment become more standardized and reasonable; the clinical pathway is continuously improved on the basis of evidence. These also demonstrate the superiority of the translational medicine model in promoting the development of the hospital.

NBIC medicine and the function of clinical diagnosis and treatment

NBIC medicine is a medical idea which is derived from “NBIC convergence technology”. “NBIC convergence technology” refers to the cooperation and integration of the four science and technology fields developing rapidly at present, including nanotechnology, biotechnology, information technology, cognitive science and so on. Simplified English for it is the “Nano-Bio-Info-Cogno” and its abbreviation is NBIC. Technology in these four fields is developing rapidly and each field has a huge potential. The integration of any two of the technologies will be very effective, so the convergence of three or four of the technologies will produce an inestimable effectiveness. To extend the definition of “NBIC convergence technology” to the medical field will yield the concept of NBIC medicine. That is, NBIC medicine will achieve the progress of medical research and practice based on the complementary advantages of different disciplines obtained from multidisciplinary coordination and cooperation in the field of medical science. As one of the diagnosis and treatment models of the research hospital, NBIC medicine is lower than integration medicine in theory level, but it is more practical. At the same time, NBIC medicine is an important part of the implementation of the translational medicine model. Only by developing NBIC medicine and conducting joint research focusing on clinical problems will mutual transformation between basic research and clinical practice be quickly and effectively achieved, so translational medicine will realize its ultimate goal of serving patients.


Functional development of research hospitals—rehabilitation medicine

With the improvement of living standards, people are not only satisfied with life-time extension, but also they have paid more attention to the improvement of the quality of life. Rehabilitation medicine focuses on improving individual life quality, not just extending the length of life. Therefore, to develop the medical rehabilitation, strengthen the rehabilitation medicine discipline construction and the penetration of medical rehabilitation in the clinical medicine department, and provide patients with comprehensive rehabilitation services, is a key function of the research hospital.

Early intervention

Early intervention is one of the vital principles of medical rehabilitation. Early medical rehabilitation intervention can improve the rehabilitation effect of patients, but also has social and economic benefits, such as shortening hospitalization days, optimizing medical resources allocation, reducing medical expenses and so on. Early rehabilitation usually starts in the acute phase of the disease, and is involved in the clinical treatment, and needs to work closely with clinical disciplines. The common form of collaboration is the stroke unit and the inter-disciplinary consultation. The main content of early medical rehabilitation varies from discipline to discipline, for example, early medical rehabilitation of neurological diseases, early medical rehabilitation of orthopedics diseases, early medical rehabilitation of heart and lung diseases, early medical rehabilitation of pediatric diseases, etc.

Comprehensive intervention

The focus of medical rehabilitation is not just the limbs and organs with dysfunction, but the whole patient. People have physical activities, mental activities, social activities and professional activities. In order to achieve the best rehabilitation effect, we must make the patients recover fully in medical, educational, occupational and social rehabilitation and other fields. The main contents of medical rehabilitation also show the comprehensive intervention of rehabilitation medicine, including the rehabilitation foundation, functional assessment of rehabilitation and rehabilitation therapy. There are three main ways of rehabilitation services: institution-based rehabilitation (IBR), community-based rehabilitation (CBR), and out-reaching rehabilitation (ORS).

System intervention

In order to more effectively integrate the resources of clinical rehabilitation and improve the curative effect of rehabilitation, it is necessary to establish a standardized sub -specialty system of rehabilitation. This can provide patients with more systematic and comprehensive rehabilitation services, further improve the effectiveness and efficiency of rehabilitation, and promote patients to return to society. Currently, the system rehabilitation of major diseases has been carried out in China are as follows: neural rehabilitation assessment and training system, including the construction of rehabilitation assessment and treatment platform for stroke, the construction of rehabilitation assessment and treatment platform for peripheral nerve injury; rehabilitation assessment and training system of muscle and bone, including the construction of rehabilitation assessment and training system of spinal stability, the construction of functional rehabilitation training platform for fracture, joint replacement surgery and so on; cardiopulmonary rehabilitation assessment and training system; sports rehabilitation assessment and training system for children; and the motor control and learning technology system. Research hospitals should also carry out scientific research in the field of medical rehabilitation to improve the level of rehabilitation services.


The core essence of the research hospital—personalized diagnosis and treatment of difficult and complicated disease

The diagnosis and treatment of difficult and complicated disease are the main tasks of the research hospital. Personalized medicine of difficult and complicated disease is the key point for the construction and development of research hospitals. It requires that the research hospital should take the personalized medicine of difficult and complicated disease as the principal function to rewrite the disease spectrum of difficult and complicated disease. Under this requirement, the research hospital needs to play its role in scientific management, personnel training, inheritance and innovation, and popularization to comprehensively promote the leaping development of research hospitals. In the management level (Figure 1), the research hospital should build up the green channel for difficult and complicated disease, improve the treatment plan of difficult and complicated disease, establish a multidisciplinary joint consultation system, improve the translational system between clinical work and research, and complete the computer- aided diagnosis and treatment module.

Figure 1 The diagnosis and treatment process diagram of difficult and complicated diseases.

At the same time, the research hospital should establish a standardized training model for difficult and complicated disease, establish an innovation research fund for difficult and complicated disease, establish an innovation incentive system for the research, diagnosis and treatment of difficult and complicated disease, and implement the system of the survival of the fittest of talents. Talent training of the research hospital should pay attention to cultivate the international vision of talents, train the creative thinking and transforming thinking, and train the special skills of talents. The research hospital should also attach importance to the function of inheritance and innovation. Inheritance is the foundation of innovation. Innovation is the source of the development of research hospitals on the basis of inheritance,

Research hospitals need to play their role in the popularization and promotion of the personalized medicine of difficult and complicated diseases by popularizing the treatment plans of difficult and complicated diseases to improve the quality of the whole society medical service. To achieve this, research hospitals should establish a personalized medicine training base of difficult and complicated diseases, establish talent selection mechanisms of lower level hospitals, establish regular visit and consultation systems, and establish promotion systems of new technologies and new methods.

The patients with difficult and complicated diseases require a combination of multi-discipline diagnosis and treatment during the whole process of their hospital admission to rehabilitation discharge, and they require a systematic analysis of their condition to select multiple therapeutic tools for targeted treatment. Its requirements for a medical model have its own characteristics. Research hospitals need to start from the management, clinical, scientific research and other aspects to explore the personalized medicine and emerging medical model from many aspects, guiding the clinical application, to improve the quality of medical services.

The emergence and application of new medical technology provides a development opportunity and challenge to the construction of research hospitals. Only making use of the latest medical technology can provide technical support for the development of research hospitals and enhance the core competitiveness of the development of research hospitals.


Social responsibility of research hospitals—inclusive health care

The social responsibility of the hospital is the obligations that the hospital must undertake, facing the health needs of the whole society and safeguarding national interests and the people’s health, when it achieves its own survival and development. Its primary purpose is to serve the public health. Inclusive health management takes the public health management as their responsibility, and is committed to devote its energy to the human health management and promotion.

The core management idea of inclusive health management is prevention. Its development idea of serving the general public health is in line with the development direction of future medicine from “disease medicine” to “health medicine”. At the same time, it combines contemporary life science frontier and TCM to promote the change of the medical model from the disease treatment oriented to be prediction and intervention oriented. It will help China to lead the world in health sciences and build inclusive health service system to meet the needs of the 1,300,000,000 population in China.

Generally, inclusive health management includes the following three basic steps: comprehensive health system assessment, individual health risk assessment and management intervention in the whole life cycle. Its technical means include health education, health promotion, health records management, health examination, health assessment and health intervention.

The development of chronic disease management, big data applications, technology integration, functional medicine, genetic testing and prediction and personalized medicine and health management will powerfully promote the development of inclusive health care.


The effective carrier of research hospitals—traditional medicine

Advanced nature of the disease prevention of TCM

TCM has advantages in the aspects of overall thinking, personalized diagnosis and treatment, and translational medicine. At present, medicine calls for attention from the focus on treatment of disease to health, which is in accordance with the theory of TCM stressing that “the best measure is to treat the disease before it happens”, and “treating disease before its onset and preventing disease from exacerbating”. It calls for attention from the treatment of local changes to the overall situation of the human body, which is in accordance with the theory of Chinese traditional medicine emphasizing the whole concept of “adaptation of human body to natural environment and five viscera correlated with each other”. It advocates the transformation from standardized treatment to personalized diagnosis and treatment, which is in accordance with the theory of TCM stressing that “treatment based on syndrome differentiation, treating diseases should suit different people, different seasons and different geographical environments”. Translational medicine advocates the idea of clinical work-basic research-clinical work, which is consistent with the characteristics of Chinese traditional medicine that “medicine and pharmacy are considered as a whole, which come from clinical work, combined with basic theory, and finally tested in clinical work”. At the same time, new concepts also provide an important prerequisite for the transformation of TCM research.

Under the condition of research hospitals, preventive treatment of disease is to make targeted prevention with the help of modern diagnosis and treatment before clinical symptoms appear clearly. The strategy for the preventive treatment of disease in the research hospital includes: making the prevention of difficult and complicated diseases become a part of the multidisciplinary comprehensive treatment for the difficult and complicated disease, opening the preventive treatment of disease clinic, opening the “winter disease cured in summer” clinic, establishing health education rooms, the new mode of health management of TCM, such as “multi-ring cut-in and status adjustment and linear interference” (Figure 2).

Figure 2 The service process of the center for preventive treatment of disease.

The advantages of the mode of holistic thinking of TCM

The concept of holistic thinking of TCM consists of two levels of meanings: first is “harmony between man and nature”, that is to put people under the large background of nature, they are an indivisible whole; second is to see the human body itself as a whole, as the human body is composed of many tissues and organs that perform different functions. The organic connection between the various tissues and organs forms the human body as a whole. TCM in the treatment of diseases follows the principle of diagnosis and treatment based on an overall analysis of symptoms and signs.

Compared with TCM, modern medicine puts too much emphasis on discipline segmentation. However, the human body is an indivisible organic whole. The result of this segmentation can only be contrary to the fact that the human body and life is an organic whole. At present, doctors lack the holistic concept, so they only focus on organs and diseases. This is not conducive to the development of medicine, therefore, we should advocate the concept of integration medicine.

How TCM can maximize its overall advantages in the treatment of difficult and complicated diseases is also the direction for research hospitals to try to explore. Generally, research hospitals can establish the multi-disciplinary joint consultation system including TCM, establish the diagnosis and treatment mode of combining traditional Chinese and western medicine for key, difficult and severe disease.

The combined multidisciplinary clinic and comprehensive diagnosis and treatment is the diagnosis and treatment development model of research hospitals. The research hospital should transform the doctor centered division system to an integrated and patient centered system, integrate the existing technical structure of the hospital to introduce multidisciplinary comprehensive clinics. This can not only shorten the waiting time and reduce the treatment process, and improve the rate of medical treatment in the unit time, but the combined diagnosis and treatment of multidisciplinary experts can focus on the system analysis of the patient’s disease to seek the best treatment plan and find out the most effective and the most quick treatment method. Some hospitals opened up a “one-stop” multidisciplinary comprehensive clinic to serve patients. Its main form is shown in Figure 3.

Figure 3 Constitution of “one-stop” multidisciplinary comprehensive clinic.

Advanced nature of personalized diagnosis and treatment model

Twenty-first century medicine will develop from “disease medicine” to “health medicine”, develop from group treatment to personalized treatment. How to implement personalized diagnosis and treatment is a common concern of many disciplines. The key of it is to clarify the research ideas and find the appropriate method and way.

Difficult and complicated disease itself has the characteristics that the cause of it is complicated and difficult to diagnosis and treat, so there is a greater need to highlight the personalized diagnosis and treatment of difficult diseases. Personalized medicine of difficult and complicated disease is an important cornerstone for the construction of research hospitals. The characteristics of personalized diagnosis and treatment of TCM is generated from the thinking rules used in the process of clinical diagnosis and treatment of TCM. The principle of diagnosis and treatment based on an overall analysis of symptoms and signs is a special kind of method used by TCM for the research and treatment of disease. Clinical medication of TCM is very personal. Depending on each patient’s syndrome differentiation, it gives the corresponding prescription treatment. Modern medicine has recognized that the change of many disease spectra is transforming from a single factor disorder to a multi-factor disorder. With this kind of disease it is often difficult to find a direct factor leading to the disease, because there are often a variety of factors interacting as both cause and effect to lead to the disease because of multi-system metabolism and regulation disorders of the human body (Figure 4).

Figure 4 Thinking of treatment according to syndrome differentiation.

Personalized diagnosis and treatment is the specific clinical diagnosis with prominent individual features and the personalized treatment corresponding to its diagnosis. The personalized diagnosis and treatment strategy of research hospitals can be organized around the individual diagnosis and treatment of the diseases that they are good at treating. They can establish personalized diagnosis and treatment plans for key diseases. For example, currently, the diagnosis and treatment of “sub-healthy state”, “chronic disease”, “senile disease”, “advanced tumor” and so on, are more and more becoming the main fields of the research and treatment of TCM.


Acknowledgements

The authors would like to thank Dr. Robert Peterson for proofreading the paper.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

doi: 10.21037/jrh.2016.09.03
Cite this article as: Yao J, Gao T. Introduction to the theory of research hospitals (series 4): medical model of the research hospital. J Res Hosp 2016;1:16.

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