Shuo Liu

Background and Objectives: IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory disorder requiring prolonged treatment, placing substantial financial burden on patients. This study compares the direct medical costs of three treatment regimens—glucocorticoid (GC), GC combined with Mycophenolate mofetil (MMF), and rituximab (RTX) —and evaluates the patients’ health-related quality of life (HR-QoL) using the EuroQol 5-Dimension 5-Level scale (EQ-5D-5 L) to assess cost-effectiveness. Methods: Our retrospective cohort study consecutively distributed EQ-5D-5 L questionnaires to treatment-naïve IgG4-RD outpatients. Patients formed three cohorts: 30 with GC, 30 with GC+MMF, and 20 with RTX. Patients on other regimens were excluded. HR-QoL was assessed using EQ-5D-5 L questionnaires and visual analog scales. Quality-adjusted life years (QALYs) were calculated, and incremental cost-effectiveness ratios were computed. Probabilistic sensitivity analysis with Monte Carlo simulations evaluated cost-effectiveness across willingness-to-pay thresholds. Results: First-year treatment costs were $1284.53 for GC, $2090.96 for GC+MMF, and $6175.97 for RTX. RTX group demonstrated the lowest relapse rate. No significant differences were observed in HR-QoL scores among groups, though visual analog scale (VAS) scores favored GC over GC+MMF. Median incremental cost-effectiveness ratios of probabilistic sensitivity analysis were $13,310/QALY for RTX versus GC and $17,412/QALY for RTX versus GC+MMF. GC demonstrated highest cost-effectiveness probability at willingness-to-pay thresholds below $15,000/QALY. Inverse probability of treatment weighting analysis confirmed these findings’ robustness after controlling for selection bias. Conclusions: While RTX offers superior efficacy with lowest relapse rates, its high price leads to limited usage in China. GC-based regimens provide reasonable outcomes at lower costs, making GC or GC+MMF more economical choices.

Interdepartmental consultations are essential for managing complex inpatient care but are often inefficient. Hospital-wide, data-driven analyses are needed to guide process improvements; yet, most existing studies have focused on single departments or specific diseases, leaving a gap in understanding hospital-level collaboration networks. Understanding these patterns is crucial for optimizing clinical workflows, reducing delays, and improving patient outcomes in large tertiary hospitals. This study aimed to analyze the distribution and network characteristics of interdepartmental consultations across a large tertiary hospital, focusing on high-frequency collaboration pairs and their disease associations. This retrospective cohort study included all interdepartmental consultations for inpatients and emergency patients at Peking Union Medical College Hospital (Beijing, China) from January 1 to December 31, 2024. Secondary data were extracted from the Hospital Information System. In total, 102,858 valid consultations involving 42 clinical departments were analyzed. Outcome measures included consultation requests and receptions per department, per capita request intensity, and pairwise collaboration volume. High-frequency collaboration pairs were defined as those with an annual consultation volume of 300 or more. Descriptive statistics (medians and IQRs) and proportions with 95% CIs were used. Consultation activity exhibited marked concentration. The Emergency Department issued the most consultation requests (19,698/102,858, 19.15%), far exceeding the median departmental request volume of 1899.5 (IQR 1359.5-3759.25). Meanwhile, the Internal Medicine Consultation Service received the highest number of consultations (10,428/102,858, 10.14%), substantially above the median reception volume of 1886.0 (IQR 521.25-4056.75) across departments. The per capita request intensity varied widely, with Critical Care Medicine highest value (21.64) vs a hospital-wide average of 0.32. Collaboration demonstrated a strong Pareto distribution: the top 5.37% (65/1210) of department pairs (65 pairs) accounted for 42.02% (43,221/102,858) of all consultations. These high-volume pairs were predominantly disease-specific. Examples include: Endocrinology-Ophthalmology primarily for diabetic and thyroid eye disease (1287/102,858, 1.25%); General Surgery-Otolaryngology mainly for preoperative thyroid airway assessment (1225/102,858, 1.19%); General Surgery-Clinical Nutrition for perioperative support (1032/102,858, 1.00%); Endocrinology-Clinical Nutrition for metabolic disease management (703/102,858, 0.68%); Orthopedics-Rehabilitation Medicine for postoperative rehabilitation (686/102,858, 0.67%); Oncology Medical Center-Clinical Nutrition for nutrition support in patients with cancer (681/102,858, 0.66%). Recurring clinical scenarios generated these stable, predictable consultation pathways. This study provides a novel, hospital-wide, network-based mapping of interdepartmental consultations using real-world data. Unlike prior work limited to single departments or diseases, it reveals that collaboration is concentrated, Pareto-like, and disease-driven. The identification of stable, disease-specific consultation pairs offers a data-driven framework for understanding multidisciplinary collaboration. These findings offer a data-driven framework for understanding multidisciplinary collaboration as a networked system. In practice, administrators and clinicians can use this evidence to prioritize resources, design standardized multidisciplinary team pathways, and implement spatial or digital interventions to reduce delays and improve patient flow and outcomes.

Background/Objectives: Patient navigation is vital for improving healthcare accessibility and patient experience in China’s public hospitals, where high patient demand meets limited medical resources. Patient navigators (PNs) assist patients through the complex healthcare system, but the lack of standardized training and evaluation hampers their ability to meet patient needs. This study piloted a Competencies Improvement Training Program (CITP) in a tertiary hospital to clarify PN competencies, design a feasible curriculum, assess its efficacy, and share insights with peer hospitals. Methods: The CITP used the Plan–Do–Check–Act (PDCA) framework and designed a curriculum with Miller’s Pyramid Model. Over 6 months, eight sessions were conducted, including theory, case studies, etc. The quasi-experimental design compared PN competencies and patient satisfaction before and after. Multiple instruments measured baseline competencies and program efficacy with a 6-month post-training follow-up. Results: A total of 75 PNs (75%) participated and completed all sessions. A total of 1189 patients were surveyed before training, 495 in the first month after training, and 502 in the 6-month follow-up. The CITP significantly boosted PN competency scores from 90.259 to 95.453, though it dipped to 92.721 by 6 months. Patient satisfaction with PN services improved modestly over 6 months. Challenges in applying theoretical knowledge to practical skills were noted, suggesting differentiated training based on navigator demographics. Patient satisfaction for aspects like politeness and tone was linked to patient age and education. Conclusions: The CITP enhanced PN core competencies and provided an evidence-based curriculum model. Future research should involve larger multi-center populations with longer-term follow-ups to validate the program’s effectiveness across diverse settings.