MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DINH THAI SON THE CURRENT SITUATION OF DIAGNOSIS, TREATMENT AND REFERRAL CAPACITY IN 2020 AND THE EFFECT
Trang 1MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
DINH THAI SON
THE CURRENT SITUATION OF DIAGNOSIS,
TREATMENT AND REFERRAL CAPACITY IN 2020 AND THE EFFECTIVENESS OF APPLYING THE TELEMEDICINE MODEL IN IMPROVING THE CAPACITY OF THE EMERGENCY DEPARTMENT,
THANH HOA PROVINCIAL GENERAL HOSPITAL
Major : Public Health Item No : 9720701
ABSTRACT OF DOCTORAL THESIS IN PUBLIC HEALTH
HANOI - 2024
Trang 2THE PROJECT WAS COMPLETED AT:
HANOI MEDICAL UNIVERSITY
Scientific Instructor:
1 Assoc.Prof Hoang Bui Hai
2 Professor Luu Ngoc Hoat, PhD, MD
Critique 1: Assoc.Prof Nguyen Thi Thuy Duong
Critique 2: Assoc.Prof Nguyen Anh Tuan
Critique 3: Assoc.Prof Nguyen Van Hien
The thesis will be defended at the University-level Thesis Grading Council, at Hanoi Medical University
Trang 3LIST OF PUBLISHED WORKS RELATED TO THE THESIS
1 Evaluate the results of applying the telemedicine model to support the diagnosis and treatment of patients in emergency between Hanoi Medical University Hospital and Thanh Hoa Provincial General Hospital Journal of Medical Research,170(9), 261-269 https://doi.org/10.52852/tcncyh.v170i9.1973
2 The current situation of referral of patients in the emergency and intensive care departments, Thanh Hoa Provincial General Hospital, 2020 Journal of Medical Research, 162(1), 247-255 https://doi.org/10.52852/tcncyh.v162i1.1342
3 Disease Patterns among Patients Seeking Emergency and Intensive Care: A single-hospital study in north central Vietnam in
2020 Asia Pacific Journal of Health Management, 19(1) https://doi.org/10.24083/apjhm.v19i1.2595
Trang 4ABBREVIATION LIST Abbreviation Meaning
ARDS Acute Respiratory Distress Syndrome
BKLN Non-communicable Diseases
CME Continuous Medical Education
CNTT Information Technology
ICT Information and Communication Technology
ICU Intensive Care Unit
KHSCC Intensive Care and Emergency Department
PACS Picture Archiving and Communication System
(non-film-based medical imaging)
TNTT Accidents and Injuries
THESIS INTRODUCTION
1 The topicality of the topic
The growing demand for healthcare poses a major challenge to the health system, requiring a quick and professional response However, the shortage of professional personnel and uneven distribution among localities are still significant barriers for the health sector This creates great pressure, promoting the search for innovative solutions to improve the efficiency of health care for people In the era of Industry 4.0, information technology is being widely applied in many fields, and health is no exception In particular, telemedicine has emerged as a potential solution, which is highly appreciated for its ability to save money and time, and improve the quality of healthcare The role of telemedicine has become even more important in the context of the global COVID-19 pandemic Telemedicine allows medical professionals to provide consultation, diagnosis and treatment for patients remotely, expanding access to medical services for people everywhere This technology not only helps to overcome geographical barriers but also contributes to reducing the pressure on the traditional health system, especially in emergency situations or when resources are limited
For the above reasons, we conducted the topic: "The current situation of diagnosis, treatment and referral capacity in 2020 and the effectiveness of applying the telemedicine model in improving the capacity of emergency departments and general hospitals of Thanh Hoa province" with the following two objectives:
1 Describe the current situation of diagnosis, treatment and referral at the emergency department, Thanh Hoa Provincial General Hospital in 2020
2 Evaluate the results of the telemedicine intervention solution between Hanoi Medical University Hospital and Thanh Hoa Provincial General Hospital
in improving the capacity to diagnose and handle severe cases at the Emergency Department and Thanh Hoa Provincial General Hospital
Trang 52 New contributions of the thesis
The research has made important contributions to improving the quality of medical care and treatment efficiency at Thanh Hoa Provincial General Hospital, namely:
Providing data on the current situation: The study provided a clear picture
of the current situation of diagnosis and treatment of cases in 2020 at Thanh Hoa Provincial General Hospital Prominent problems such as traumatic brain injury, intracranial injury, and an increase in circulatory diseases have been noted This provides a basis for planning more effective interventions for severe and emergency cases
Affirming the importance of Telemedicine: The Telemedicine model implemented at hospitals has proven its ability to improve the quality of emergency and intensive care, especially for severe and complex cases Thanks
to this model, the mortality rate in the group of patients receiving the Telemedicine intervention was significantly lower (2% compared to 6.1% in the control group), indicating a positive impact on treatment outcomes
Reducing the rate of hospital transfers: One of the important contributions
of the project is to significantly reduce the rate of hospital transfers to the upper line The group of patients receiving telemedicine intervention had a hospital transfer rate of only 25%, lower than 28.3% in the control group This helps reduce the pressure on upper-level hospitals and optimize local medical resources
Improving the quality of treatment: The project has helped improve treatment outcomes for the group of patients who receive telemedicine interventions With 25.2% of patients in this group having better progress, while the percentage of patients in the control group had a higher rate of poor treatment results (12.1%) This confirms the significant difference in the quality
of care and the ability to respond to complex cases thanks to Telemedicine Capacity development of the medical team: The project has contributed to the capacity building of doctors and medical staff at the hospital The successful application of Telemedicine shows the ability of the medical team to adapt and master new technologies, contributing to the sustainable development of the local health system
These results affirm the importance and effectiveness of the application of telemedicine in the emergency and resuscitation system at local hospitals, contributing to significantly improving the quality of medical services for the community
3 Layout of the thesis
The thesis consists of 130 pages, of which the question section is 02 pages, the overview of the document is 35 pages, the research objects and methods are
14 pages, the research results are 35 pages, the discussion is 41 pages, the conclusion is 02 pages and the recommendation is 02 pages The thesis has 26
boards, 114 references with 23 Vietnamese documents, 91 English documents
Trang 6CHAPTER 1.LITURATURE REIVEW
1.1 Definition and concept
1.1.1 Telemedicine
Telemedicine, a term coined in the 1970s, synonymous with
"telemedicine", denotes the use of Information and Communication Technology (ICT) to improve treatment outcomes by increasing access to health care and information The World Health Organization has adopted the general description
"Telehealth is a health care service, in which distance is an important factor, because all health professionals use information and communication technology
to exchange valid information for diagnosis, treatment and prophylaxis, research and evaluation for the ongoing training of health providers aimed at promoting the health of individuals and their communities"
1.1.2 Design and implementation research
Implementation research is a multidisciplinary field that focuses on addressing challenges in the application of medical interventions into practice Although the concept has evolved significantly over the past decade, there is still
a lot of confusion about its scope and exact definition The term "implement" is derived from the Latin "implere", which means to complete or implement
1.2 Disease structure at the emergency department and intensive care
Disease structure and mortality play an important role in the development
of health care policy, especially in emergency departments, where medical emergencies are treated Mortality is the main indicator of treatment outcomes
In Vietnam, the disease pattern is changing with the increase in communicable diseases such as cardiovascular and cancer This requires medical teams to be highly specialized and equipped with modern equipment to ensure effective emergency care and reduce mortality
non-1.3 Telemedicine in emergency and intensive care
Telemedicine is increasingly widely applied in the field of emergency and intensive care This technology helps overcome the shortage of highly qualified personnel and reduce the cost of medical care Tele-ICU, a system that combines audiovisual and computer technology, provides the foundation for telecare, not replacing but complementing on-site services by standardizing processes and leveraging resources
Telemedicine requires high-speed network infrastructure, modern computer equipment, high-resolution screens, quality video cameras, and backup power
Trang 7systems In addition, mobile devices and electronic medical records play an important role in supporting information access and remote diagnosis
Telemedicine also faces legal and security requirements, especially in the protection of electronic health information The three main measures are administrative, physical, and technical protection, in order to ensure data privacy and security
The history of telemedicine applications in intensive care began in 1975 in the United States and continues to grow, especially with the implementation of the first tele-ICU system in 2000 Tele-ICU has helped reduce mortality and hospital stays thanks to decision-making technology and remote patient monitoring, despite the high initial cost
1.4 Application of telemedicine in emergency and intensive care
Telemedicine in Emergency and Intensive Care is an advanced system that combines audiovisual and computer technology to provide telemedicine care to critically ill patients in ICU units The system includes monitoring equipment, cameras, microphones, and assistive software, allowing medical professionals to monitor the patient's condition remotely and intervene as needed Telemedicine helps address staffing shortages, improve the quality of care, and improve treatment outcomes Models such as continuum of care, shift care, and remote monitoring have been widely implemented, benefiting both hospitals and patients Many studies show that telemedicine can reduce mortality, length of hospital stay, and increase adherence to best practices in the ICU However, the specific effect still needs more research to apply in different medical contexts
1.5 Telemedicine in improving the capacity of diagnosis and treatment at emergency and intensive care departments
The implementation of Tele-ICU and telemedicine services is becoming an important solution to solve the challenges of providing high-quality medical services in rural and remote areas where there are difficulties in human resources and facilities The personnel model in the Tele-ICU plays a decisive role, with the effectiveness depending on the operating time and professional qualifications
of the medical staff involved
Telemedicine is not only a direct support in medical care but also a powerful tool in improving the capacity of healthcare workers through teleconsultations These consultations allow doctors to learn, develop diagnostic, treatment, and management skills, and build confidence and decision-making
Trang 8Continuous training through telemedicine has proven effective in improving expertise, especially in areas where medical resources are scarce
In addition, telemedicine improves the quality of local health services, contributes to reducing ICU mortality and complications, and increases treatment adherence Intelligent decision support technology also helps optimize the care process and reduce the overload of warnings in the ICU system
1.6 Thanh Hoa Provincial General Hospital
Thanh Hoa Provincial General Hospital, established in 1899, is currently a Grade I hospital with 1,200 beds and 1,308 officials The hospital has state-of-the-art infrastructure and performs many advanced medical techniques such as laparoscopic surgery, pancreatic mass resection, kidney transplantation, and cardiovascular intervention In particular, the hospital is the first provincial facility in Vietnam to successfully transplant a kidney from a brain-dead donor The hospital is constantly improving its professional quality through training, technical transfer, and cooperation with leading experts, in order to master modern techniques and develop a high-quality medical team
1.7 Emergency and Intensive Care Center, Hanoi Medical University Hospital
The Department of Emergency and Intensive Care, established on June 25,
2014 under the decision of Hanoi Medical University, has effectively undertaken medical and surgical emergency cases In 2017, the department expanded and established a stroke unit, meeting the increasing demand for stroke treatment The department applies many advanced techniques such as fibrinolysis, continuous dialysis, and hypothermia after circulatory arrest The department also uses software to support consultations, and at the same time organizes emergency transportation and continuous training for staff As a practice facility
of Hanoi Medical University, the faculty also participates in line direction training and scientific research, with many international publications, affirming its position in the international medical community
Trang 9CHAPTER 2 RESEARCH OBJECTS AND METHODS
2.1 Object of study
For Objective 1:
All patients are examined and treated at the Resuscitation and Emergency Department, Thanh Hoa Provincial General Hospital in 2020 Data from the medical records of patients admitted from January 1, 2020 to December 31,
2020 at this hospital were used for analysis Medical records need to be fully informed; If important information is missing, it will be excluded from the
treating doctor or the leader of the Resuscitation and Emergency Department
Selection criteria: Patients have complex clinical conditions, need timely monitoring and intervention; have severe medical conditions that require high
professional support; The family consented to telemedical intervention
Control group: The patient was treated at the Resuscitation and Emergency Department of Thanh Hoa Provincial General Hospital in 2020 (historical
2.2.1 Time and place of research:
Time: 01/2022 to 08/2024 at Thanh Hoa Provincial General Hospital Data
collection time: from 01/2022 to 05/2023
2.2.2 Research design:
Objective 1: Design a study describing a series of common diseases (case series), retrospectively collecting data from medical records to survey the current
status of examination, emergency, treatment, referral and death in 2020
Objective 2: Design implementation research, combining quantitative and qualitative research Quantitative study of telemedicine intervention on the patient group at the Emergency Department and comparison with the historical
Trang 10control group Qualitative research collects opinions from medical staff and
hospital leaders
2.2.3 Telemedicine intervention model
The telemedicine model at the Resuscitation and Emergency Department is built according to a centralized model with the Operation Center at Hanoi Medical University Hospital and the connecting unit at Thanh Hoa Provincial General Hospital The process includes identifying needs, exchanging information via Zalo group chat or hotline, consulting via network connection
and Zoom software, and going online if necessary
Steps to conduct a consultation
Determination of needs: Request to conduct telemedicine consultations
based on the patient's health status
Prepare medical records: Summarize records, prepare patients, and notify
consultation times
Telemedicine consultation: ISBAR medical record summary report,
discussion and treatment direction
Record keeping: Save the consultation minutes in the medical record Steps to go online
Prepare to go to the room: Contact Hanoi Medical University Hospital,
prepare the patient and the connecting device
Online room coordination: Report the course of the disease, evaluate and
discuss with the treating doctor
Absorb and implement work: Implement agreed tasks and adjust plans if
Trang 112.2.5 Sample selection and study sample size
Goal 1: All patients will be examined and treated in 2020 Extracted 30,670
patients
Goal 2: Minimum sample size of 89 per group In fact, 100 patients were
admitted to the intervention group, paired with 99 patients in the control group 2.2.6 Data analysis management
Data is cleaned, encoded, and analyzed using STATA 15.0 The variables are described by concentration and dispersion, comparing the differences by
statistical tests
2.2.7 Data collection tools and methods
Medical record data: Extracted from hospital management software and
managed by Excel
Qualitative research: Focus group discussion
2.2.8 Error management in research
Medical record data: Ensure accuracy through training for IT staff
Historical control group: Meticulous pairing to ensure equivalence with the
intervention group
Qualitative research: Ensure accurate information by keeping it confidential and clearly explaining the purpose of the research to the audience
2.2.9 Ethics in research
The research is ethically approved according to certificate No
15/HDKH-BV of Thanh Hoa Provincial General Hospital on 06/09/2021 The data is used for research purposes only
Trang 12CHAPTER 3 RESULT Result of Objective 1: describe the current situation of examination, emergency, treatment, referral and death of Thanh Hoa Provincial General Hospital in 2020
3.1 General information of patients examined, treated and referred at Thanh Hoa Provincial General Hospital in 2020
Table 3.1: General information of the study subjects
Table 3.2 General information on cases of examination, emergency and
treatment at Thanh Hoa Provincial General Hospital
Trang 13Table 3.3 Disease chapters according to ICD-10
Disease chapter (n=27,152)
Chapter XI - Diseases of the digestive system 5,863 21.6 Chapter XIX - Injuries, poisoning and some other
Chapter IX - Diseases of the Circulatory System 5,512 20.3 Chapter XIV - Diseases of the Genitourinary
Chapter III - Diseases of the Blood and
Blood-Forming Organs and Certain Disorders Involving
the Immune Mechanism
Chapter XXI - Factors Influencing Health Status
Chapter IV - Endocrine, Nutritional, and Metabolic
Chapter XX - External Causes of Morbidity and
Chapter XVI - Certain Conditions Originating in