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    "What Goes Around Comes Around": Lessons Learned from Economic Evaluations of Personalized Medicine Applied to Digital Medicine. Phillips Kathryn A,Douglas Michael P,Trosman Julia R,Marshall Deborah A Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research BACKGROUND:The growth of "big data" and the emphasis on patient-centered health care have led to the increasing use of two key technologies: personalized medicine and digital medicine. For these technologies to move into mainstream health care and be reimbursed by insurers, it will be essential to have evidence that their benefits provide reasonable value relative to their costs. These technologies, however, have complex characteristics that present challenges to the assessment of their economic value. Previous studies have identified the challenges for personalized medicine and thus this work informs the more nascent topic of digital medicine. OBJECTIVES:To examine the methodological challenges and future opportunities for assessing the economic value of digital medicine, using personalized medicine as a comparison. METHODS:We focused specifically on digital biomarker technologies and multigene tests. We identified similarities in these technologies that can present challenges to economic evaluation: multiple results, results with different types of utilities, secondary findings, downstream impact (including on family members), and interactive effects. RESULTS:Using a structured review, we found that there are few economic evaluations of digital biomarker technologies, with limited results. CONCLUSIONS:We conclude that more evidence on the effectiveness of digital medicine will be needed but that the experiences with personalized medicine can inform what data will be needed and how such analyses can be conducted. Our study points out the critical need for typologies and terminology for digital medicine technologies that would enable them to be classified in ways that will facilitate research on their effectiveness and value. 10.1016/j.jval.2016.08.736
    Description of an online hospital platform, China. Wu Dan,Hesketh Therese,Shu Haihua,Lian Wannian,Tang Weiming,Tian Junzhang Bulletin of the World Health Organization 10.2471/BLT.18.226936
    The plight of China's village doctors. Ni Qingqiang,Xie Feng,Wu Mengchao Lancet (London, England) 10.1016/S0140-6736(16)32466-7
    Is digital medicine different? The Lancet Lancet (London, England) 10.1016/S0140-6736(18)31562-9
    Rapid health systems change: online medical consultations to fight COVID-19. Wang Haiyin,Song Peipei,Gu Yuanyuan,Schroeder Elizabeth,Jin Chunlin Annals of translational medicine 10.21037/atm-20-2618
    Understanding the Function Constitution and Influence Factors on Communication for the WeChat Official Account of Top Tertiary Hospitals in China: Cross-Sectional Study. Shen Lining,Wang Shimin,Chen Wenqiang,Fu Qiang,Evans Richard,Lan Fuqiang,Li Wei,Xu Juan,Zhang Zhiguo Journal of medical Internet research BACKGROUND:Widespread adoption and continued developments in mobile health care technologies have led to the improved accessibility and quality of medical services. In China, WeChat, an instant messaging and social networking app released by the company Tencent, has developed a specific type of user account called WeChat official account (WOA), which is now widely adopted by hospitals in China. It enables health care providers to connect with local citizens, allowing them to, among other actions, send regular updates through mass circulation. However, with the diversity in function provided by WOA, little is known about its major constitution as well as the influence factors on the WeChat communication index (WCI). The WCI has been widely used in social media impact ranking with various types of WeChat content to fully reflect the dissemination and coverage of tweets as well as the maturity and impact of WOA. OBJECTIVE:There are two typical WOAs available to users, namely, WeChat subscription account (WSSA) and WeChat service account (WSVA). The biggest difference between them is the frequency of messages transmitted. This study aimed to explore the function constitution of WSVA adopted by top tertiary hospitals in China and the major contributors of the WCI score. METHODS:A total of 681 top tertiary hospitals were selected from the Hospital Quality Monitoring System; the WOA of every top tertiary hospital was retrieved in the WeChat app. We divided core functional items of WSVAs using categorical principal component analysis. To elicit the factors that influenced the use of WSVA, quantile regression was employed to analyze the WCI score. RESULTS:From the 668 WOAs identified, adoption of WSVAs (543/668, 81.3%) was more than that of WSSAs (125/668, 18.7%). Functional items of WSVAs were categorized into four clusters: (1) hospital introduction, (2) medical services, (3) visiting assistants, and (4) others. With regard to the influence factors on the WCI, the impact of the activity index of WSVA and the total visiting number of outpatients and emergencies on WCI were statistically significant and positive in all quantiles. However, the year of certification, the type of hospital, the year of public hospital reform, and the number of beds merely affected the WCI at some quantiles. CONCLUSIONS:Our findings are considered helpful to tertiary hospitals in developing in-depth functional items that improve patient experience. The tertiary hospitals should take full advantage of times of posting and provide high-quality tweets to meet the various needs of patients. 10.2196/13025
    Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. Li Peiyi,Luo Yunmei,Yu Xuexin,Wen Jin,Mason Elizabeth,Li Weimin,Jalali Mohammad S Journal of medical Internet research BACKGROUND:As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE:This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS:We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS:Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS:We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. 10.2196/17221
    Nurses' Attitudes toward, and Needs for Online Learning: Differences between Rural and Urban Hospitals in Shanghai, East China. Xing Weijie,Ao Linjun,Xiao Huiting,Cheng Li,Liang Yan,Wang Junqiao International journal of environmental research and public health Health professionals need continuing education to maintain their qualifications and competency. Online learning increases the accessibility and flexibility of continuing education. Assessment of nurses' attitudes toward, and needs for, online learning can provide suggestions regarding learning program design and delivery. This study aimed to evaluate Chinese nurses' attitudes toward, and needs for, online learning, and to explore the differences in attitudes and needs between nurses working in rural and urban hospitals. This work is a secondary analysis of a multicenter cross-sectional study conducted in Shanghai in 2015 ( = 550). Multiple regression techniques were used to determine the factors associated with nurses' attitudes toward, and needs for, online learning. Results showed that nurses in rural hospitals had more positive attitudes toward online learning (102.7 ± 14.2) than those in urban hospitals (98.3 ± 12.9) ( < 0.001). For rural hospitals, nurses who could use computers and access the internet in their workplace reported more positive attitudes than those who could not. For urban hospitals, nurse educators showed significantly more positive attitudes than others. Communication skills (86.5%) and patient education (86.3%) were the most commonly-reported learning needs for nurses regardless of their working settings. Chinese nurses were willing to adopt online learning as a continuing education method. Nurses working in rural hospitals displayed more positive attitudes toward, and needs for, online learning than those working in urban hospitals. Nursing educators and managers should develop online learning programs and provide appropriate support to fulfill nurses' learning needs, especially for those working in rural healthcare settings. 10.3390/ijerph15071495
    Internet-Based Sharing Nurse Program and Nurses' Perceptions in China: Cross-Sectional Survey. Huang Rendong,Xu Mei,Li Xiuting,Wang Yinping,Wang Bin,Cui Naixue Journal of medical Internet research BACKGROUND:China is currently piloting a "Sharing Nurse" program that aims to increase the accessibility of nursing services to at-home patients by enabling patients to order nursing services using mobile apps or online platforms. OBJECTIVE:This study aims to assess nurses' perceptions of the Sharing Nurse program, including their acceptance, concerns, needs, and willingness to take part in the program. METHODS:A total of 694 nurses participated in the questionnaire survey. The survey collected their sociodemographic and work-related information and their perceptions of the Sharing Nurse program using a self-developed questionnaire. RESULTS:The 694 respondents agreed that the Sharing Nurse program could provide patients with better access to nursing care (n=483, 69.6%). Their main concerns about the program were unclear liability division when medical disputes occur (n=637, 90.3%) and potential personal safety issues (n=604, 87%). They reported that insurance (n=611, 88%), permits from their affiliated hospital (n=562, 81.0%), clear instructions concerning rights and duties (n=580, 83.6%), real time positioning while delivering the service (n=567, 81.7%), and one-key alarm equipment (n=590, 85.0%) were necessary for better implementation of the program. More than half of the respondents (n=416, 60%) had an optimistic attitude toward the development of the Sharing Nurse program in China. However, only 19.4% (n=135) of the respondents expressed their willingness to be a "shared nurse." Further analyses found that nurses with a master's degree or above (χ=28.835, P<.001) or from tertiary hospitals (χ=18.669, P<.001) were more likely to be aware of the Sharing Nurse program and that male nurses were more willing to be shared nurses (Z=-2.275, P=.02). CONCLUSIONS:The Chinese Sharing Nurse program is still in its infancy and many refinements are needed before it can be implemented nationwide. Generally, Chinese nurses are positive about the Sharing Nurse program and are willing to participate if the program is thoroughly regulated and supervised. 10.2196/16644
    Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study. Xu Xingyan,Cai Yingying,Wu Siying,Guo Jianhui,Yang Le,Lan Jieli,Sun Yi,Wang Bingbing,Wu Jieyu,Wang Tinggui,Huang Shuna,Lin Yawen,Hu Yuduan,Chen Mingjun,Gao Xuecai,Xie Xiaoxu Journal of medical Internet research BACKGROUND:Internet hospitals in China are being rapidly developed as an innovative approach to providing health services. The ongoing COVID-19 pandemic has triggered the development of internet hospitals that promote outpatient service delivery to the public via internet technologies. To date, no studies have assessed China's internet hospitals during the COVID-19 pandemic. OBJECTIVE:This study aimed to elucidate the characteristics of China's internet hospitals and assess the health service capacity of these hospitals. METHODS:Data on 711 internet hospitals were collected from official websites, the WeChat (Tencent Inc) platform, smartphone apps, and the Baidu search engine until July 16, 2020. RESULTS:As of July 16, 2020, 711 internet hospitals were developed in mainland China. More than half of these internet hospitals (421/711, 59.2%) were established during 2019 (206/711, 29%) and 2020 (215/711, 30.2%). Furthermore, about one-third (215/711, 30.2%) of internet hospitals were established at the beginning of 2020 as an emergency response to the COVID-19 epidemic. The 711 internet hospitals consisted of the following 3 types of hospitals: government-oriented (42/711, 5.91%), hospital-oriented (143/711, 20.11%), and enterprise-oriented internet hospitals (526/711, 73.98%). The vast majority of internet hospitals were traditional hospitals (526/711, 74%). Nearly 46.1% (221/711) of internet hospitals requested doctors to provide health services at a specific web clinic. Most patients (224/639, 35.1%) accessed outpatient services via WeChat. Internet hospitals' consulting methods included SMS text messaging consultations involving the use of graphics (552/570, 96.8%), video consultations (248/570, 43.5%), and telephone consultations (238/570, 41.8%). The median number of available web-based doctors was 43, and the median consultation fees of fever clinics and other outpatient clinics were ¥0 (US $0) per consultation and ¥6 (US $0.93) per consultation, respectively. Internet hospitals have provided various services during the COVID-19 pandemic, including medical prescription, drug delivery, and medical insurance services. CONCLUSIONS:The dramatic increase of internet hospitals in China has played an important role in the prevention and control of COVID-19. Internet hospitals provide different and convenient medical services for people in need. 10.2196/21825
    Mobile health technology combats COVID-19 in China. Wu Jieyu,Xie Xiaowei,Yang Le,Xu Xingyan,Cai Yingying,Wang Tinggui,Xie Xiaoxu The Journal of infection China empowers mobile health technologies to fight against COVID-19 pandemic. The success of mobile health here may be a useful reference for other parts of the world. We explore China's application of mobile health technologies to replenishing traditional public-health and social approaches for mitigating and suppressing COVID-19, and found that Internet hospitals alleviate the unavailability, inaccessibility, and inequity of health services during the outbreak; the fact-check and information-release platforms reduce the spread of misinformation; and the infection risk scoring systems facilitate restoring the order of production and life. 10.1016/j.jinf.2020.07.024
    China empowers Internet hospital to fight against COVID-19. Sun Shuangyi,Yu Keting,Xie Zhen,Pan Xiaoting The Journal of infection 10.1016/j.jinf.2020.03.061
    Internet-Based and Mobile-Based General Practice: Cross-Sectional Survey. Qiu Yan,Liu Ying,Ren Wen,Qiu Yunqing,Ren Jingjing Journal of medical Internet research BACKGROUND:Globally, mHealth is increasing as a promising technology for promoting the quality of health care. Thus, a growing number of internet hospitals have been established in China to avail all its advantages. However, no study has investigated the service scope and patient satisfaction of the internet hospital to date. OBJECTIVE:The objective of our study was to explore the features of outpatients in general practice, the disease information, and the satisfaction through an internet rating site. METHODS:We collected data from the internet hospital of the First Affiliated Hospital, Zhejiang University between February 2016 and February 2017. Patients visited Web-based clinic via a computer or smartphone. The data included patients' demographic characteristics, disease information, and patients' comments. RESULTS:We enrolled 715 patients with 365 health-related problems. All health conditions involved diseases ranging from internal medicine, surgery, gynecology and obstetrics, pediatrics, dermatology, ophthalmology, stomatology to emergency. Among them, 63.1% patients (451/715) visited traditional hospitals for further management, 25.3% (181/715) had prescriptions, laboratory, or imaging examination appointment, 1% (9/715) used emergency service, and 10% (74/715) needed routine follow-up. All patients received health education. Almost all patients gave positive feedback and 4-5-star rating. CONCLUSIONS:The internet hospital is suitable for all health conditions with high satisfaction only when patients have the access to internet via a computer or smartphone. 10.2196/jmir.8378
    The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study. Ding Liang,She Qiuru,Chen Fengxian,Chen Zitong,Jiang Meifang,Huang Huasi,Li Yujin,Liao Chaofeng Journal of medical Internet research BACKGROUND:Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called "internet hospital plus drug delivery" (IHDD) has been developed in China, but little is known about this platform. OBJECTIVE:The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China. METHODS:The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients' gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis. RESULTS:A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China. CONCLUSIONS:The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service. 10.2196/19678
    The Impact of Internet Medical Information Overflow on Residents' Medical Expenditure Based on China's Observations. Han Junqiang,Zhang Xiaodong,Meng Yingying International journal of environmental research and public health : The rapid rise of medical expenditure is a common problem in the field of public health around the world, but the challenges for the Chinese government are even greater. How to control the rapid rise in medical expenditure and reduce individuals' economic burden when receiving medical treatment has become one of the core issues that the Chinese government urgently needs to solve. The aim of this study was to evaluate the impact of Internet use on individuals' medical expenditure and further discuss the potential impact mechanism. : The data used in this study were from the 2018 China Family Panel Studies (CFPS) conducted by Peking University. The Heckman sample selection model was used to analyse the impact of Internet use on individuals' medical expenditure. : Internet use reduced the medical expenditure of individuals by 6.19%; high frequency Internet use reduced the medical expenditure of individuals by 15.1%, while low frequency Internet use had no impact. In addition, Internet use had different impacts on individuals' medical expenditure at different levels of hospitals. Specifically, Internet use reduced the medical expenditure of individuals who received medical treatment at general hospitals by 9.63%, and high frequency Internet use reduced the medical expenditure of individuals by 22.2%. However, Internet use had no impact on the medical expenditure of individuals who received medical treatment at primary hospitals. : Findings from this study underscore the importance of Internet use as an important role in reducing individuals' medical expenditure. The use of the Internet can significantly reduce the level of individuals' medical expenditure, and high frequency Internet use has a greater effect. However, Internet use has different impacts on individuals' medical expenditure among different levels of hospitals. The reduction effect of Internet use on individuals' medical expenditure is mainly concentrated in general hospitals but has no effect in primary hospitals. 10.3390/ijerph17103539
    Survey on the demand for adoption of Internet of Things (IoT)-based services in hospitals: Investigation of nurses' perception in a tertiary university hospital. Kang Seungjin,Baek Hyunyoung,Jung Eunja,Hwang Hee,Yoo Sooyoung Applied nursing research : ANR In hospitals, while the opportunities and challenges of Internet of Things (IoT) applications are continuously increasing, research on what IoT services are actually in demand in hospitals has not been conducted. In this study, a survey of working hospital nurses was conducted to confirm the demand for IoT services. A total of 1086 (90.2%) participants responded. Five out of seven points for all service questions were obtained, which indicates a high demand for all services. The highest demand was shown for a vital sign device interface system. A comparison between ward and non-ward nurses showed that individuals working in wards had a high demand for patient care related IoT services, and individuals working in non-ward departments demonstrated a high demand for IoT services to improve work efficiency. Overall, the results provide a framework for future directions of services that can improve the efficiency of medical staff and health outcomes of patients. 10.1016/j.apnr.2019.03.005
    Effects of Internet Hospital Consultations on Psychological Burdens and Disease Knowledge During the Early Outbreak of COVID-19 in China: Cross-Sectional Survey Study. Li Lin,Liu Gang,Xu Weiguo,Zhang Yun,He Mei Journal of medical Internet research BACKGROUND:Coronavirus disease (COVID-19) has become a global threat to human health. Internet hospitals have emerged as a critical technology to bring epidemic-related web-based services and medical support to the public. However, only a few very recent scientific literature reports have explored the effects of internet hospitals on psychological burden and disease knowledge in major public health emergencies such as the COVID-19 pandemic. OBJECTIVE:The aim of this study was to explore the role of internet hospitals in relieving psychological burden and increasing disease knowledge during the early outbreak of the COVID-19 pandemic. METHODS:This survey was conducted from January 26 to February 1, 2020, during the early outbreak of COVID-19 in China. The platform used for the consultation was the WeChat public account of our hospital. To participate in the study, the patient was required to answer a list of questions to exclude the possibility of COVID-19 infection and confirm their willingness to participate voluntarily. Next, the participant was directed to complete the self-report questionnaire. After the internet consultation, the participant was directed to complete the self-report questionnaire again. The questionnaire included sections on general information, the General Health Questionnaire-28 (GHQ-28), and the participant's worries, disease knowledge, and need for hospital treatment. RESULTS:The total number of internet consultations was 4120. The consultation topics mainly included respiratory symptoms such as cough, expectoration, and fever (2489/4120, 60.4%) and disease knowledge, anxiety, and fear (1023/4120, 24.8%). A total of 1530 people filled out the questionnaires before and after the internet consultation. Of these people, 1398/1530 (91.4%) experienced psychological stress before the internet consultation, which significantly decreased after consultation (260/1530, 17.0%) (χ=1704.8, P<.001). There was no significant difference in the number of people who expressed concern about the COVID-19 pandemic before and after the internet consultation (χ=0.7, P=.43). However, the degree of concern after the internet consultation was significantly alleviated (t=90.638, P<.001). The main worries before and after consultation were the dangers posed by the disease and the risk of infection of family members. The scores of the self-assessment risk after the internet consultation were significantly lower than those before consultation (t=95.694, P<.001). After the consultation, the participants' knowledge of the symptoms, transmission routes, and preventive measures of COVID-19 was significantly higher than before the consultation (t=-106.105, -80.456, and -152.605, respectively; all P<.001). The hospital treatment need score after the internet consultation decreased from 3.3 (SD 1.2) to 1.6 (SD 0.8), and the difference was statistically significant (t=45.765, P<.001). CONCLUSIONS:During the early outbreak of COVID-19, internet hospitals could help relieve psychological burdens and increase disease awareness through timely and rapid spread of knowledge regarding COVID-19 prevention and control. Internet hospitals should be an important aspect of a new medical model in public health emergency systems. 10.2196/19551
    Internet Hospitals in China: Cross-Sectional Survey. Xie Xiaoxu,Zhou Weimin,Lin Lingyan,Fan Si,Lin Fen,Wang Long,Guo Tongjun,Ma Chuyang,Zhang Jingkun,He Yuan,Chen Yixin Journal of medical Internet research BACKGROUND:The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated. OBJECTIVE:The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity. METHODS:We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as "Internet hospital," "web hospital," or "cloud hospital." All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. RESULTS:We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). CONCLUSIONS:Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China's Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done. 10.2196/jmir.7854
    Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study. Gong Kai,Xu Zhong,Cai Zhefeng,Chen Yuxiu,Wang Zhanxiang Journal of medical Internet research BACKGROUND:During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public. OBJECTIVE:The aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China. METHODS:Online epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees' group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees' motivation and the doctors' recommendation for an offline visit were compared. Risk factors affecting the counselees' tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed. RESULTS:A total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees' motivation and the doctors' recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic. CONCLUSIONS:Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public's ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19. 10.2196/18908
    The Internet Hospital as a Telehealth Model in China: Systematic Search and Content Analysis. Han Yangyang,Lie Reidar K,Guo Rui Journal of medical Internet research BACKGROUND:The internet hospital is an innovative organizational form and service mode under the tide of internet plus in the Chinese medical industry. It is the product of the interaction between consumer health needs and supply-side reform. However, there has still been no systematic summary of its establishment and definition, nor has there been an analysis of its service content. OBJECTIVE:The primary purpose of this study was to understand the definition, establishment, and development status of internet hospitals. METHODS:Data on internet hospitals were obtained via the Baidu search engine for results up until January 1, 2019. Based on the results of the search, we obtained more detailed information from the official websites and apps of 130 online hospitals and formed a database for descriptive analysis. RESULTS:By January 2019, the number of registered internet hospitals had expanded to approximately 130 in 25 provinces, accounting for 73.5% of all provinces or province-level municipalities in China. Internet hospitals, as a new telehealth model, are distinct but overlap with online health, telemedicine, and mobile medical. They offer four kinds of services-convenience services, online medical services, telemedicine, and related industries. In general, there is an underlying common treatment flowchart of care in ordinary and internet hospitals. There are three different sponsors-government-led integration, hospital-led, and enterprise-led internet hospitals-for which stakeholders have different supporting content and responsibilities. CONCLUSIONS:Internet hospitals are booming in China, and it is the joint effort of the government and the market to alleviate the coexistence of shortages of medical resources and wasted medical supplies. The origin of internet hospitals in the eastern and western regions, the purpose of the establishment initiator, and the content of online and offline services are different. Only further standardized management and reasonable industry freedom can realize the original intention of the internet hospital of meeting various health needs. 10.2196/17995
    Determinants of Patients' Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China. Li Dehe,Hu Yinhuan,Pfaff Holger,Wang Liuming,Deng Lu,Lu Chuntao,Xia Shixiao,Cheng Siyu,Zhu Ximin,Wu Xiaoyue Journal of medical Internet research BACKGROUND:Internet hospitals show great potential for adequately fulfilling people's demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients' intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients' behavioral intention is necessary to support the development of internet hospitals in China and promote patients' intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. OBJECTIVE:The purpose of this study is to identify the determinants of patients' intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). METHODS:The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. RESULTS:A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001). CONCLUSIONS:Perceived behavioral control and perceived severity of disease are the most important determinants of patients' intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients' adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients' intention to use online inquiry services provided by internet hospitals. 10.2196/22716