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2021 Vol. 28, No. 4
Published: 2021-08-25
 
 
289 Practice and reflection on the reform of performance distribution in functional departments of public hospitals
Gao Libo，Yu Changhai，Hao Xiulian，Zhang Tingting
DOI: 10.3969/j.issn.1006-5253.2021.04.001
The practical exploration of the performance distribution reform of functional departments of public hospitals helps to continuously establish and improve the modern hospital management system, promote the transformation from extensive management to fine management, and realize the high-quality development of public hospitals. This paper analyzes the current situation of performance and personnel management status in the sample hospital, Binzhou Medical University Hospital, and puts forward the existing problems and deficiencies at this stage. By clarifying the objectives of performance distribution reform, implementing various steps such as post sorting, manual compilation, department and post value evaluation and scheme revision, this paper puts forward the performance reform scheme of functional departments, summarizes the reform experience and puts forward the prospect of further improvement, in order to provide reference for the indepth research of performance reform in public hospitals in the future.
2021 Vol. 28 (4): 289-293 [Abstract] ( 67 ) HTML (1 KB)  PDF (917 KB)  ( 115 )
294 Analysis of the report of 2 586 medical safety (adverse) events in a tertiary children′s hospital
Guo Chuhao，Long Yingchun，Qiu Shuang，Deng Li
DOI: 10.3969/j.issn.1006-5253.2021.04.002
Objective To analyze the characteristics and rules of medical safety (adverse) events in a tertiary children′s hospital and provide countermeasures and suggestions for hospital quality and safety. Methods A retrospective analysis was performed on 2 586 medical safety (adverse) events reported in a tertiary children′s hospital from January 2018 to December 2020. Results The constitute ratios of rank Ⅱ and Ⅳ adverse events were decreasing and the constitute ratios of rank Ⅲ was rising (P<0.001). The proportion of departments participating in reporting adverse events were increasing (P<0.05). ADR and fall remained in the top two in three years, while consumables, ADR of blood transfusion, and iatrogenic skin injury events had an increasing trend (P<0.05). The proportion of needle stick injuries and medical equipment events had a decreasing trend (P<0.05). The proportion of technicians and other occupations reporting adverse events increased (P<0.001). Conclusion Standardizing the management of adverse events and actively creating a safe cultural atmosphere in the hospital can enhance the awareness of reporting adverse events in the departments. We should also scientifically improve the reporting system, broaden a variety of reporting channels, and strengthen the publicity and training for new and low seniority employees to enhance individual reporting enthusiasm.
2021 Vol. 28 (4): 294-297 [Abstract] ( 67 ) HTML (1 KB)  PDF (856 KB)  ( 91 )
298 Meta analysis of the effect of contraceptive intervention on postpartum women′s reproductive health
Liu Ni，Shan Li, Chu Guanghua
DOI: 10.3969/j.issn.1006-5253.2021.04.003
Objective To evaluate the effect of contraceptive intervention on postpartum women and provide reference for improving their reproductive health. Methods CNKI, Wanfang, Weipu database, PubMed and Embase were searched for randomized controlled trials of contraceptive intervention and routine nursing. Literature was screened and data were extracted according to inclusion and exclusion criteria. After quality evaluation, meta analysis was performed with RevMan 5.2 software. Results Twenty-three randomized controlled trials were included, with a total of 16 684 subjects followed up. Metaanalysis showed that intervention could increase breastfeeding rates (OR=1.89,95%CI:1.42-2.51), and only the high-quality study intervention had no significant effect on the total nutritional rate of milk for five months after delivery (P=0.870). The intervention could increase the half-year contraceptive rate after delivery (OR=4.37, 95%CI：2.00-9.52), and the difference remained statistically significant after excluding low-quality studies (OR=0.17，95%CI: 0.13-0.21). The intervention could increase the one-year contraceptive rate after delivery (OR=2.83, 95%CI：1.67-4.82). The intervention could reduce the postpartum accidental pregnancy rate (OR=0.55, 95%CI：0.42-0.73), but the differences of four high quality studies were not statistically significant (OR=0.64, 95%CI：0.27-1.49). The intervention could reduce the rate of induced abortion (OR=0.35, 95%CI：0.26-0.47), but the quality of the documents that described the index was low. Conclusion Contraceptive interventions may affect postpartum breastfeeding rates, contraceptive rates, postpartum unintended pregnancy rates, and induced abortion rates. Because of the low quality of the inclusion of some documents, more large samples and high quality random control studies are required for further confirmation.
2021 Vol. 28 (4): 298-304 [Abstract] ( 49 ) HTML (1 KB)  PDF (1867 KB)  ( 181 )
305 Establishment and verification of a nomogram of postoperative de lirium in elderly patients undergoing thoracic surgery
Zheng Shu， Zhou Peimin，lü Zhenye， Fu Xiangshang， Feng Rui
DOI: 10.3969/j.issn.1006-5253.2021.04.004
Objective To establish a nomogram to predict the risk of postoperative delirium (POD) in elderly patients undergoing thoracic surgery and to verify the accuracy of the model. Methods All elderly patients who underwent thoracic surgery from December 2018 to December 2020 in Wenzhou People′s Hospital were included in this retrospective study. A least absolute shrinkage and selection operator (LASSO) regression model was used to reduce data dimensionality and determine the best predictors for inclusion in the nomogram. Multivariable logistic regression analysis was applied to establish the prediction model represented by a nomogram incorporating the selected feature variables. The predicting model′s characteristics of the discrimination, calibration and clinical applicability were analyzed using the-C-index, the calibration diagram, and the decision curve. Results Five variables, including age, diabetes mellitus, NRS-2002 score, Pittsburgh sleep index, and operation time, were identified and applied to develop a nomogram. With a -C-index of 0.798, the model showed good discrimination. The calibration diagram and the Hosmer-Lemeshow test indicated well agreement between the probability as predicted by the nomogram and the actual probability. The decision curve analysis indicated that the nomogram could be applied clinically if the risk threshold was between 11% and 93. Conclusion The nomogram, incorporating age, diabetes mellitus, NRS-2002 score, Pittsburgh sleep index, and operation time, was an individualized, predictive model of clinical significance, which may help medical staff early identify postoperative delirium in elderly patients undergoing thoracic surgery.
2021 Vol. 28 (4): 305-310 [Abstract] ( 70 ) HTML (1 KB)  PDF (1288 KB)  ( 216 )
311 Construction of prediction model for malignant risk in ovarian tumor patients based on blood routine and CA125 index
Yu Xiao， Shen Qundi
DOI: 10.3969/j.issn.1006-5253.2021.04.005
Objective To construct a prediction model of malignant risk in ovarian tumor patients based on blood routine and CA125 index. Methods A retrospective observational study was carried out in the department of obstetrics and gynaecology from January 2015 to January 2019. The general clinical data, blood routine, CA125 and postoperative pathology of the patients were collected. The statistical analysis of SPSS 25.0 and R 3.6.1 software was applied to constructing the nomograph prediction model for evaluation. Results We collected 92 patients with ovarian tumor surgery who met the inclusion criteria, including 56 cases of ovarian cancer and 36 cases of benign ovarian tumor. Neutrophil to lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were independent factors for malignant risk in patients with ovarian tumors. Using CA125, NLR and PLR as variables, the nomograph prediction model was established. The area under curve (AUC) calculated by ROC curve was 0.983, the accuracy of the model was good, and the consistency of the evaluation model using calibration curve was good. Conclusion NLR elevation and PLR elevation are independent risk factors for ovarian cancer patients. The prediction model based on CA125, NLR and PLR indicators for ovarian cancer patients has good accuracy. It has certain value to quickly and simply carry out ovarian cancer risk determination and can be further verified by multi-center and large sample data.
2021 Vol. 28 (4): 311-314 [Abstract] ( 68 ) HTML (1 KB)  PDF (1150 KB)  ( 216 )
315 Mediating effect of resilience on the relationship between coping style and self-regulatory fatigue in young and middle-aged breast cancer survivors
Zhou Lifang, Li Qiong, Que Qiaoyan
DOI: 10.3969/j.issn.1006-5253.2021.04.006
Objective To analyze the relationship between coping style, resilience and self-regulatory fatigue in young and middle-aged breast cancer survivors, and to explore the mediating effect of resilience between coping style and self-regulatory fatigue. Methods Totally 263 young and middle-aged breast cancer survivors were investigated by convenient sampling in the department of breast cancer from June 2018 to June 2020. Pearson method was used to analyze the relationship between coping style, mental resilience and self-regulation fatigue, and bootstrap method was used to test the mediating effect of mental resilience on coping style and self-regulation fatigue. Results The total score of self-regulatory fatigue was (51.36±8.79), positive coping style was (29.04±4.65), negative coping style was (16.89±5.47), and resilience was (20.96±5.82). The self-regulated fatigue score (53.15±7.88) of patients with breast cancer aged 40 to 59 years old was higher than that of patients aged 18 to 39 (50.68±9.04). The self-regulated fatigue score of patients with a monthly household income of ≤3 000 ( 53.79±9.31) was higher than that in other groups. The Pearson correlation analysis showed that the self-regulated fatigue score was negatively correlated with the positive coping style score and the resilience score (r =-0.269, -0.275, P<0.01), and positively correlated with the negative coping style score (r=0.414, P<0.01). Bootstrap test indicated that resilience mediated the relationship between positive coping style and self-regulatory fatigue, with the indirect effect -0.12, and resilience mediated the relationship between negative coping style and self-regulatory fatigue, with the indirect effect 0.04.Conclusion Young and middle-aged breast cancer survivors have the problem of self-regulated fatigue. Coping style and resilience could affect self-regulatory fatigue, and resilience could mediate the relationship between coping style and self-regulatory fatigue.
2021 Vol. 28 (4): 315-320 [Abstract] ( 60 ) HTML (1 KB)  PDF (860 KB)  ( 187 )
321 Research on grouping hospitalization expenses of patients with choledocholithiasis based on decision tree
Yin Yuhua，Wu Huatun，Zhu Jianqian
DOI: 10.3969/j.issn.1006-5253.2021.04.007
Objective To study the case mix mode and cost payment standard of patients with common bile duct stones, so as to provide a reference for medical institutions to formulate correct hospitalization expenses grouping and improve medical efficiency. Methods The data came from the home page information of 3 990 patients with common bile duct stones diagnosed and treated in a large tertiary general hospital in Zhejiang Province from 2017 to 2020. After the relevant indicators were selected, multiple stepwise regression analysis was used to analyze the influencing factors of hospitalization expenses. The selected influencing factors were incorporated into the decision tree model, and the decision tree E-CHAID method was used to construct the hospitalization expense grouping plan and payment standard for choledocholithiasis. Results The number of days of hospitalization, surgery, and age were the classification nodes of the decision tree. The decision tree was divided into 8 groups. The coefficient of variation -CV- within each group was less than 0.4. The reduction of inter-variance was 0.67. The intra-group homogeneity and inter-group heterogeneity were good. Conclusion Using the decision tree E-CHAID method to group common bile duct stone cases into hospitalization expenses is scientific and reasonable. Medical institutions in various regions can verify the grouping based on local data and optimize the grouping plan.
2021 Vol. 28 (4): 321-324 [Abstract] ( 56 ) HTML (1 KB)  PDF (1188 KB)  ( 176 )
325 Analysis of clinical characteristics of 17 099 inpatients with injury and poisoning in a traditional Chinese medicine hospital
Zuo Yang
DOI: DOI:10.3969/j.issn.1006-5253.2021.04.008
Objective investigate the characteristics and occurrence regularity of trauma patients and to provide scientific basis for further control and prevention of accidental injuries by retrospectively analyzing the injuries and poisoning cases admitted to a hospital of traditional Chinese medicine from 2015 to 2019 Methods ICD-10 was used to retrieve the inpatient medical records with the main diagnosis code S00-T97. Excel and SPSS 21.0 software were used to analyze the data. Results The average age of male patients was significantly lower than that of female patients with 17 099 injuries and poisoning. In terms of seasonal trend, the peak of annual admissions was in the third quarter, followed by the fourth quarter, and the first quarter was the trough period. The top 5 injuries were lower extremity injuries, shoulder and upper extremity injuries, chest injuries, abdominal, lower back, lumbar vertebra and pelvis injuries, and foreign body entering the natural opening. Falling and traffic accidents were the top 2 external causes of injury and poisoning of male and female patients. According to the analysis of external causes by age, falling was the highest among people over 60 years old, and traffic accidents were the highest among people between 15 and 44 years old. The total fatality rate of 17 099 injury poisoning patients was 0.32%, ranking the first cause of death due to toxic substances poisoning. Conclusion Although the injury is an emergency, there are certain rules in the occurrence of different genders, ages and various kinds of injury poisoning. Through retrospective analysis of these cases, we can find out the corresponding preventive measures to reduce the injury.
2021 Vol. 28 (4): 325-328 [Abstract] ( 53 ) HTML (1 KB)  PDF (1051 KB)  ( 96 )
329 Analysis on the disease composition of elderly inpatients in secondary and above medical institutions in Ningbo from 2017 to 2019
Zhang Qihua，Liu Jiwei， Luo Shenglan， Yang Yongchuan
DOI: 10.3969/j.issn.1006-5253.2021.04.009
Objective To understand the disease composition of elderly inpatients and provide basis for the prevention and rehabilitation of elderly diseases. Methods From the "Zhejiang Health Information Network Direct Report System", the first page information of inpatient medical records of elderly people (≥60 years old) in secondary and above medical institutions in Ningbo from 2017 to 2019 was obtained, including gender, age, discharge time, main diagnosis and the international disease classification coding, etc., and the main diagnosis of patients was classified and summarized according to ICD-10. Excel was used for statistical analysis of the data. Results There were totally 1 146 121 elderly people in secondary and above medical institutions in Ningbo from 2017 to 2019, and inpatients increased year by year. The male population was more than the female population (1.23∶1). The top 5 discharge diseases were circulatory system diseases, factors affecting health status and contact with health care institutions, respiratory system diseases, digestive system diseases and tumors, accounting for 61.88% of all elderly discharged patients. The composition and order of disease classification were different in different age groups, and the difference waw statistically significant(χ2=69 948.412,P＜0.001). Conclusion There were differences in disease classification among different years, gender and age groups. Therefore, hospital decisionmakers should optimize the allocation of medical resources, and pay attention to the quality of medical services for the elderly population.
2021 Vol. 28 (4): 329-333 [Abstract] ( 52 ) HTML (1 KB)  PDF (928 KB)  ( 153 )
334 Structural variation analysis and influencing factors of hospitalization expenses of patients with malignant tumor
Yun Xiaoyan, Chen Zhonghu, Yang Yan.
DOI: 10.3969/j.issn.1006-5253.2021.04.010
Objective To explore the structural changes of average hospitalization expenses of cancer patients from 2014 to 2019, and to study the influencing factors of hospitalization expenses. Methods We selected the inpatients with malignant tumor in a tertiary hospital from 2014 to 2019 as the research objects and collected the information on the first page of the inpatient medical records. The inpatient expenses, diagnosis and treatment were fitted by path analysis model to study the influencing factors directly and indirectly affecting the inpatient expenses. Results From 2014 to 2019, the proportion of medicine in the hospitalization expenses of patients with malignant tumor was 36.13%, followed by medical service expenses with 21.76%, and the lowest was the cost of material 0.16%; the contribution rate of other expenses and medical service expenses was 37.44% and 34.83% respectively, and the contribution rate of nursing expenses and rehabilitation expenses was 1.07% and 0.15%. Factors directly affecting the average hospitalization expenses of patients with malignant tumor were hospitalization days, surgery, years of hospitalization, marriage, age, gender, and medical payment method. Among them, the most influential factor was surgery, with an effect coefficient of 0.798, followed by hospitalization days, with an effect coefficient of 0.629. Conclusion The proportion of medicine cost in the average hospitalization expenses of patients with malignant tumor has decreased, the contribution rate of the structural change of the operation expenses is ideal, the proportion of medical service expenses has gradually increased, and the optimization control still needs to be strengthened; the influencing factors of the average hospitalization expenses are relatively complex, in order to effectively reduce the operation expenses, we should strictly grasp the surgery indications and control the hospitalization days.
2021 Vol. 28 (4): 334-338 [Abstract] ( 49 ) HTML (1 KB)  PDF (1141 KB)  ( 286 )
339 Analysis of influencing factors of hospitalization expenses for patients with chronic obstructive pulmonary disease based on diagnosis related groups
Li Yongfeng，Yu Chuhong
DOI: 10.3969/j.issn.1006-5253.2021.04.011
Objective To explore the factors influencing the hospitalization expenses of patients with chronic obstructive pulmonary disease (COPD) in groups related to disease diagnosis. Methods The DRG evaluation of 989 COPD inpatients in a tertiary public hospital in Jiangmen City in 2019 was analyzed. The coefficient of variation CV was used for intra-group comparison, the rank sum test was used for inter-group comparison, and multiple linear regression was used for multivariate analysis of factors influencing hospital expenses. Results COPD patients were mainly distributed in three DRGs, including chronic airway obstructive disease with important comorbidities and concomitant diseases (ET11), chronic airway obstructive disease with comorbidities and concomitant diseases (ET13), and chronic airway obstructive disease without comorbidities and concomitants Disease (ET15). The grouping of ET11 was poor, and the grouping of ET13 and ET15 was better. The time index of the ET11 group was higher than 1, the time consumption index of the ET13 and ET15 groups was lower than 1, and the expense index of the 3 groups were all higher than 1. The difference in hospitalization expenses among the 3 groups was statistically significant. The influencing factors were the length of stay in hospital, rescue, age, and full self-finance for the group ET11; the influencing factors of hospitalization expenses in the ET13 group were the length of hospitalization and the new rural cooperative medical insurance; the influencing factors of hospitalization expenses in the ET15 group were the length of hospitalization. Conclusion DRGs can be used as a management tool to control the hospitalization expenses of COPD patients, and to reduce the hospitalization expenses of COPD patients, thereby to reduce patients′ disease burden.
2021 Vol. 28 (4): 339-342 [Abstract] ( 56 ) HTML (1 KB)  PDF (837 KB)  ( 141 )
343 Application of office automation in the quality management of operation related data on the front page of medical records
Li Jizhi，Zhu Zhonghua，Liu Renying
DOI: 10.3969/j.issn.1006-5253.2021.04.012
Objective To analyze the application effect of office automation (OA) in the quality management of operation related data on the front page of medical records, and to provide practical basis for the innovation of operation related information management mode on the front page of medical records. Methods From September 2018 to August 2019 (the first stage), 13 004 cases of operation related information on the front page of medical records were selected as the control group, and the routine management method was used; from September 2019 to August 2020 (the second stage), 13 306 cases of operation related data on front page of medical records in the whole hospital were taken as the experiment group, and on the basis of conventional management methods, OA mobile terminal of medical record management was added. The two groups were compared on the missing rate of surgery on the first page of medical records, the accuracy rate of surgery/operation coding on the first page of medical records, the accuracy rate of surgery/operation data (the number of surgeries, the number of interventional surgeries, the number of minimally invasive surgeries, the number of key surgeries, the accuracy rate of surgery/operation level), and the satisfaction of medical staff on the operation information retrieval service on the front page of medical records. Results The missing rate of surgery on the first page of medical records in the experimental group was lower than that in the control group, the accuracy rate of surgery coding and surgery/operation data on the first page of medical records in the experimental group was higher than that in the control group, and the satisfaction of medical staff on operation information retrieval in the experimental group was higher than that in the control group, with statistical significance (P<0.05). Conclusion The application of OA in medical record management can reduce the missing rate of surgery, improve the accuracy of surgery coding and surgery/operation data on the front page of medical records, improve the satisfaction of medical staff on operation related data extraction service, and provide more accurate, comprehensive and efficient operation information service for the development of hospital information, which is worthy of popularization and application.
2021 Vol. 28 (4): 343-345 [Abstract] ( 49 ) HTML (1 KB)  PDF (841 KB)  ( 117 )
346 Design and application of specimen delivery system based on health information exchange platform in multi hospital districts
Lin Siyang
DOI: 10.3969/j.issn.1006-5253.2021.04.013
Objective To change the status quo of manual specimen delivery in the hospital, improve the delivery efficiency, ensure the correctness of specimen information, reduce all kinds of errors in the process of delivery, realize specimen delivery between multi hospital districts, and  manage and control the whole process of specimen delivery in the hospital. Methods The specimen delivery system is constructed based on HIE hospital information platform. The process was designed for outpatient and inpatient departments respectively. The system supported specimen recording, packaging, delivering, receiving, management, query and setting.Results The system has been put into service in more than 20 outpatient departments, more than 80 inpatient departments and the eastern district of the hospital. In the first quarter of 2021, 163 422 specimen packages including 715 460 specimens were delivered. It realized the closed-loop and unified management of specimen delivery in the hospital. It improved the accuracy and timeliness of specimen delivery. It located the problem accurately, reduced the error rate, improved the medical service level and brought convenience to medical workers.Conclusion The hospital has completed the construction and management of specimen delivery informatization. The design which was based on HIE hospital information platform effectively reduces the interface complexity and coupling between systems, improves the quality of medical service and achieves satisfactory results.
2021 Vol. 28 (4): 346-350 [Abstract] ( 57 ) HTML (1 KB)  PDF (1559 KB)  ( 132 )
351 Elserly people′s pension willingness and influencing factors of choosing home-based care of population aged 60 and above
Cai Min，Zhang Yaoguang，Xie Xueqin，Wu Shiyong
DOI: 10.3969/j.issn.1006-5253.2021.04.014
Objective To learn about the pension willingness and factors affecting the choice of home care willingness of the elderly population, and to provide the evidence for improving life status of the elderly population, better providing full cycle services, and promoting healthy aging. Methods Data of the Sixth National Health Service Statistical Survey were used to analyze the nursing situation and pension willingness of the elderly population in different regions, different family conditions, different social demographic characteristics and different disability status, and logistic regression was used to analyze the influencing factors of the elderly population′s choice of homebased care. Results Eleven point eight percent of the elderly needed to be taken care of for their daily life, and daily care was provided 52.5% by spouses and 42.9% by children. And 90.7% of the elderly were inclined to home-based care, urban and rural areas, sex, age, marital status, educational level, family economic status, disability degree, the number of chronic diseases, family size were all influencing factors of elderly pension willingness. The probability of wanting home care was lower in urban areas than in rural areas (OR=0.625,  95%CI: 0.589-0.663); it was higher for men than for wornen(OR=1.122,95%CI:1.062-1.187); and it was higher for 70-79 years old (OR=1.219, 95%CI:1.147-1.296) and 80 years old and above (OR=1.598, 95%CI: 1.433-1.782) than for 60-69 years old; it was lower for unmarried (OR=0.476) and divorce (OR=0.600) than for married; it was lower for the elderly with educational levels of primary school (OR=0.742), junior middle school (OR=0.437), and senior high school or above（OR=0.352）than for those without literacy (P<0.01); it was higher for elderly people not living alone than for those living alone (P<0.01).  Conclusion The elderly with older age, lower educational level, poor family economic status and large family size are more likely to hope for care at home.Combined with the elderly′s pension willingness, in view of the health status, nursing and care needs, it is necessary to establish and improve a service system based on family care, to explore the design of long-term care system, and to protect the health rights and interests of the elderly.
2021 Vol. 28 (4): 351-356 [Abstract] ( 69 ) HTML (1 KB)  PDF (862 KB)  ( 708 )
357 Evaluation on allocation of health resources in Shenzhen based on the rank sum ratio
Liang Yuan，Xia Xiaoqiong
DOI: 10.3969/j.issn.1006-5253.2021.04.015
Objective To evaluate the allocation of health resources in Shenzhen, and to provide basis for optimizing resources allocation in the 14th five-year plan. Methods The number of beds per 1 000 population, the number of health personnel per 1 000 population, the number of health technicians per 1 000 population, the number of doctors per 1 000 population, the number of nurses per 1 000 population, in 10 districts of Shenzhen in 2019 were evaluated with RSR method. Results The RSR regression equation of health resources in Shenzhen of 2019 was RRS=2.066－0.291VP, R2=0.970, F=259.993, P＜0.001. The allocation of health resources in Shenzhen was divided into three levels, the first grade (more): Futian, Luohu, Nanshan, and Pingshan; the second grade (medium): Guangming, Longgang, Yantian and Dapeng; the third grade (less): Bao'an, Longhua. And the differences were statistically significant (P＜0.05). Conclusion The overall allocation of health resources in Shenzhen is good, and there are obvious differences among districts. The per capita health resources in Futian, Luohu and Nanshan are higher than those in Guangming, Longgang, Dapeng, Bao′an and Longhua.
2021 Vol. 28 (4): 357-359 [Abstract] ( 54 ) HTML (1 KB)  PDF (843 KB)  ( 75 )
360 Preliminary research about diagnosis related groups based on ICD-11
Huang Feng，Fu Tinghui，Zheng Jianpeng
DOI: 10.3969/j.issn.1006-5253.2021.04.016
Objective ICD-10, the basic data standard for diagnosis related groups (DRG), will be gradually replaced by ICD-11 starting from 2022. This paper studies ICD-11′s support for DRG, which is beneficial to the construction of grouping scheme and provides guidance for disease coding. Methods Three mapping tables from ICD-10 clinical modification to ICD-11 were established to replace the definition of CN-DRG diagnostic code respectively, and three new DRG groupers were formed to replace the ICD-10 coding data in the first page of medical records respectively. The new groupers were used to group for analysis and comparison. Results Before and after the conversion of single mapping, the number of enrolled cases was equal, with 3 206 229 cases; the number of enrolled DRG groups was equal, with 780 cases; the number of enrolled cases in each DRG group was equal. After using the cluster code mapping conversion, the number of the groups in which cases changed was 722, and the enrollment rate decreased to 98.1%; after using the stem code mapping conversion, the number of the groups in which cases changed was 746, and the enrollment rate decreased to 97.1%. Conclusion CN-DRG can support DRG grouping of the first page data of ICD-11 diagnostic code based on mapping; in order to better meet the DRG grouping requirements, the current ICD-11 coding needs to be further refined.
2021 Vol. 28 (4): 360-364 [Abstract] ( 94 ) HTML (1 KB)  PDF (957 KB)  ( 153 )
365

Automatic implementation of ANOVA of repeated measurement design data based on C# and R language

Automatic implementation of ANOVA of repeated measurement design data based on C# and R language[J]. journal1, 2021,28(4): 365-371')" href="#"> Guo Yingxuan，Chen Da，Zhang Shuangzhe，Huang Changke，Lian Hengli
DOI: 10.3969/j.issn.1006-5253.2021.04.017
Objective Based on C# language and R language, a software is developed, which is convenient for clinicians to use. It is used to realize the automation of variance analysis of repeated measurement design data. Methods First, the statistical analysis data are imported into the software by C# language, then the R language command script is invoked to complete the ANOVA and the result output of the repeated measurement design data. Finally, the example in the 5th edition of medical statistics published in 2020 is used, combined with the example results and SPSS operation results, to verify the effect of the automation of the software. Results The results of statistical analysis included basic statistical description, repeated measurement ANOVA and result chart of pairwise comparison within the group. Based on the combination of C# language and R language, the running results of the statistical software are completely consistent with the results of manual calculation and analysis of teaching materials and SPSS operation. The operation is simple and the results are intuitive, which greatly surpasses the repeated operation of manual analysis and SPSS menu selection in efficiency; at the same time, the low-level errors in manual analysis and SPSS operation steps are avoided to the greatest extent, and the results are presented automatically, which reduces the errors in judgment and selection of results, and ensures the accuracy and standardization of results. Conclusion The software can automatically realize the single factor, two factor and two / multi-level ANOVA of repeated measurement design data, which is worthy of clinical application.
2021 Vol. 28 (4): 365-371 [Abstract] ( 58 ) HTML (1 KB)  PDF (2501 KB)  ( 430 )
372 Application of VBA in the field of hospital statistics
Li Xinhao，Zhou Huoming，Lai Fuhu，Xu Jun，Deng Juanjuan， Luo Yan
DOI: 10.3969/j.issn.1006-5253.2021.04.018
Objective To explore the application of VBA language in the field of hospital statistics. Methods By writing VBA language of Microsoft office software, the computer can efficiently complete daily basic medical data daily report of outpatients and inpatients, monthly department medical quality publicity data, multidimensional and multi index query department data. Results Through the use of VBA language, the hospital realized the automatic filling of daily outpatient and inpatient medical data template, the automatic verification of inpatient transfer data, and the rapid filling of daily template data; by collecting the medical quality control data of each major functional department every month, it can be automatically split into independent Excel files according to the specified format and sent to each clinical department; the access database visualization method is used to conveniently query the multi index data of clinical departments. Conclusion VBA language can make accurate statistics of data, reduce manual errors, improve the efficiency of data processing, improve the quality of data statistics, ensure the reliability of data statistics, and help hospital statisticians get rid of the daily repetitive boring work, so as to focus on higher quality of mental work.
2021 Vol. 28 (4): 372-379 [Abstract] ( 56 ) HTML (1 KB)  PDF (2245 KB)  ( 112 )
380 Random sampling of medical records based on SAS
Gu Yuting, Weng Jun, Peng Zhigang
DOI: 10.3969/j.issn.1006-5253.2021.04.019
Objective Random sampling of medical records is one of the important work in medical records management. This paper systematically introduces the method of using SAS software to quickly obtain the random samples of medical records which reflect the overall situation accurately. Methods This paper takes the international authoritative statistical analysis software (SAS) for running environment, introducing the importing of medical record data and the applying of the surveyselect process to the random sampling systematically, and also providing the SAS program which is commonly used in both simple and stratified random sampling (including single layer and multiple layer). Results Compared with the random number table, Excel function or random sampling based on subjective will, the random sampling using SAS software is of higher efficiency, which improves the standardization and the scientificity of random sampling in medical record management. Conclusion Using SAS software for random sampling in daily medical record management is convenient and efficient, therefore is worthy of reference and widespread use by the majority of medical record management workers.
2021 Vol. 28 (4): 380-384 [Abstract] ( 72 ) HTML (1 KB)  PDF (332 KB)  ( 215 )
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