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2021 Vol. 28, No. 5
Published: 2021-10-25
 
 
385 Progress of syndromic surveillance in COVID-19 epidemic
Luo Chun, Peng Aiyu, Zong Huiying, Ning Peishan, Yan Junxia, Deng Jing, Shi Jingcheng, Feng Xiangling, Huang Yun, Yu Renhe, Li Xingli, Hu Guoqing
DOI: 10.3969/j.issn.1006-5253.2021.05.001
.The global epidemic of the new type of coronavirus pneumonia (COVID-19) has caused significant adverse effects on people′s health and social economic development. Syndromic surveillance is of great significance to the prevention and control of COVID-19 epidemic. This article reviewed the data of various documents and official websites, summarized the application progress and deficiencies of syndromic surveillance in the current COVID-19, to make recommendations and provide references for future symptom monitoring.
 
2021 Vol. 28 (5): 385-388 [Abstract] ( 69 ) HTML (1 KB)  PDF (1101 KB)  ( 171 )
389 Disability status of the elderly aged 60 and above at home in China and its influence factors
Cai Min, Zhang Yaoguang, Xie Xueqin, Wu Shiyong
DOI: 10.3969/j.issn.1006-5253.2021.05.002
Objective To learn about the disability status of the elderly aged 60 and above at home in China and its influence factors, and provide evidence for improving the health status of the elderly population and making corresponding policies for the elderly. Methods Data of Chinese national health service survey and Katz index scale were used to analyze the disability status of the elderly population in different regions and different social demographic characteristics, different family economic status and different health status and the factors influencing their disability. Results The survey results showed that 6.7% of the elderly people had different degrees of disability; rural disability was more serious than urban disability; with the increase of age, the degree of disability increased, and 20.1% of the population aged 80 and above had different degrees of disability. Multivariate logistic regression analysis showed that factors affecting disability were sex, age, marital status, education, economic status, chronic illness status, physical exercises, hearing, vision, dementia etc. Men (OR=1.369), old age (ORgroup 70-79=1.568, ORgroup≥80=3.472), widowed (OR=1.248), with chronic diseases (ORwith 1 chronic disease=2.140, ORwith 2 chronic disease=3.478, OR≥3 chronic disease=5.764), visual difficulty (ORmoderate difficulty=1.249, ORextremely difficulty=1.538), hearing difficulty (ORneed to raise voice=1.647, ORcan′t hear clearly=3.271), dementia（OR=6.559）were the risk factors. High education level (ORPrimary school=0.876, ORjunior middle school=0.861, ORsenior high school or above=0.757), high income (ORmiddle income group=0.833, ORhigher income group=0.856, ORhighest income group=0.858), Active physical exercise every week (OR1-2 times=0.405, OR3-5 times=0.357，OR≥6 times=0.331) were the protective factors of disability of the elderly. Conclusion In order to reduce the occurrenceof disability, it is necessary to strengthen health education, strengthen exercises, provide suitable working and living environment for the elderly to avoid falls and maintain social adaptability, and effectively prevent chronic diseases and strengthen chronic disease management to delay the loss of function of the elderly.
2021 Vol. 28 (5): 389-394 [Abstract] ( 82 ) HTML (1 KB)  PDF (936 KB)  ( 163 )
395 Quality evaluation of breast conserving surgery patients based on hierarchical clustering and its influence factors
Wei Li, Wang Chao, Liu Meina
DOI: 10.3969/j.issn.1006-5253.2021.05.003
Objective To cluster the patients undergoing breast conserving surgery by hierarchical clustering, determine the treatment quality of each group combined with the average utilization rate of evaluating indicators, analyze the influence factors for the treatment quality, and provide theoretical guidance for improving the treatment quality for breast conserving surgery patients. Methods We selected quality evaluation indicators of breast conserving surgery, and collected medical records of breast conserving surgery patients; the patients were clustered by using the Jaccard similarity coefficient, and the average utilization rates were calculated to determine the level of the treatment quality based on denominator-based weight method; we also analyzed the influence factors of the treatment quality using multiple logistic regression. Result Two hundred and seventy-nine patients were selected and divided into two groups based on hierarchical clustering: group 1 was the low-quality group with 108 patients, accounting for 38.7%, and the average utilization rate of evaluation indicators was 68.4%; group 2 was the high-quality group with 171 patients, accounting for 61.3%, and the average utilization rate of evaluation indicators was 89.1%. The indicators with significant difference in the utilization rate between the two groups were radiotherapy after breast-conserving surgery, pathological report recording surgical margins, and preoperative cytological or histological diagnosis (P<0.001), and the difference was 86.46%, 30.09% and 20.74%. Multivariate logistic regression analysis showed that: living in a city (OR=2.461, 95%CI: 1.259-4.812), high income (OR=2.580, 95%CI: 1.520-4.380), complications (OR=1.990, 95%CI: 1.104-3.587), pathological stage II (OR=2.511, 95%CI: 1.474-4.278), and patients treated in specialized hospitals (OR=8.407, 95%CI: 4.738-14.917) tended to have higher quality of treatment (P<0.05). Conclusion Hierarchical clustering combined with average utilization rate of evaluation indicators could distinguish patients' treatment quality well. The more use of radiotherapy after breast-conserving surgery, pathological report to record surgical margins and preoperative cytological or histological diagnosis may improve the quality of care better. Doctors should pay more attention to the quality of care for patients living in rural areas, with low income, without complications and in higher pathological stages of tumor.
2021 Vol. 28 (5): 395-400 [Abstract] ( 49 ) HTML (1 KB)  PDF (980 KB)  ( 59 )
401 Prediction of infection incidence of carbapenem-resistant pseudomonas aeruginosa by ARIMA time series model
Gao Shengchun, Wu Hongmei
DOI: 10.3969/j.issn.1006-5253.2021.05.004
Objective To predict the infection incidence of carbapenemresistant pseudomonas aeruginosa (CRPA) by multiple seasonal autoregressive integrated  moving average model（ARIMA）, so as to provide the basis for the development of control strategy of CRPA. Methods The timeseries model of ARIMA was established using CRPA infection data from January 2016 to December 2019 in our hospital, and then the model was validated using the data from January 2020 to September 2020 to evaluate the prediction effect of the model. Results After modeling and fitting, it is concluded that ARIMA（0，1，1）×（0，1，1）12 is the best model. The normalized BIC of model fitting is 3.461, and the coefficient of determination R2 is 0.426. According to the Bayes criterion, the model with the minimum BIC value and the maximum R2 value is the optimal one; the Ljung-Box Q statistics are Q=16.02 and P=0.38, indicating that the residual belongs to the white noise value, and the prediction of this model is relatively suitable. After the model is established, the ARIMA prediction analysis is performed on the CRPA infection rate from January 2020 to September 2020. The results show that the actual incidence trend from January 2020 to September 2020 is relatively consistent with the predicted curve, indicating the accuracy and the forecast of the ARIMA model have a better result. Conclusion ARIMA model can accurately simulate and predict CRPA infection rate and provide a reference for the prevention and control of multi-drug resistant bacteria infection.
2021 Vol. 28 (5): 401-404 [Abstract] ( 68 ) HTML (1 KB)  PDF (1372 KB)  ( 81 )
405 Construction of risk prediction model for abnormal renal function caused by antibiotics in elderly inpatients
Zheng Jia, Ke Meifang, Xu Tianyan
DOI: 10.3969/j.issn.1006-5253.2021.05.005
Objective To construct a risk prediction model for abnormal renal function caused by antibiotics in elderly hospitalized patients. Methods A retrospective analysis was conducted on the clinical data of 208 elderly inpatients in a tertiary hospital in Zhejiang Province from March 2017 to June 2019. Single factor and logistic regression were used to analyze the independent risk factors of renal dysfunction caused by antibiotics in elderly inpatients. And a risk prediction model was established for abnormal renal function caused by antibiotics in elderly hospitalized patients. Results There were statistical differences in age, abnormal thyroid function, history of diabetes, type of antibiotics, history of hypertension, and combined antibiotics between patients with abnormal renal function and those without abnormal renal function (P<0.05). Logistic regression analysis showed that age≥65 years old (OR=3.915, 95%CI: 1.589-9650), abnormal thyroid function (OR=4.892, 95%CI: 2.000-11.965), a history of diabetes (OR=5.277,95%CI:2.014-13.824) use of aminoglycoside antibiotics (OR=3.975, 95%CI:1.617-9.773), a history of hypertension (OR=3.270, 95%CI: 1.387-7.711), and combined antibiotics (OR=3.197, 95%CI: 1.373-7.442) were independent risk factors for renal dysfunction due to antibiotic use in elderly hospitalized patients (P<0.05). The established nomogram model for predicting the abnormal renal function caused by antibiotics in elderly hospitalized patients  and the verification resultsshowed that the predicted value was basically consistent with the measured value. The ROC curve of the abnormal renal function risk nomogram had an AUC of 0.848 (95% CI ：0.812-0.884), suggesting that the predictionaccuracy of the model was acceptable. Conclusion Age≥65 years old, abnormal thyroid function, history of diabetes, use of aminoglycoside antibiotics, history of hypertension, and combined antibiotics are independent risk factors for renal dysfunction caused by antibiotics in elderly hospitalized patients, and the above six factors can be combined clinically to take targeted measures to prevent and treat renal dysfunction.
2021 Vol. 28 (5): 405-408 [Abstract] ( 54 ) HTML (1 KB)  PDF (1133 KB)  ( 155 )
409 Influence of anxiety state during pregnancy on the way of delivery, delivery process and pregnancy outcome of parturients
Jiang Tingting, Chen Yao, Zhou Xuewei, Wang Xiaomei
DOI: 10.3969/j.issn.1006-5253.2021.05.006
Objective To investigate the influence of anxiety during pregnancy on the way of delivery, the course of labor and pregnancy outcome. Methods One hundred parturients who gave birth in the obstetrics department of our hospital from January 2018 to January 2020 were selected as the research objects. All parturients were given SelfRating Anxiety Scale (SAS) to assess their anxiety during pregnancy, and according to the SAS score, all parturients were divided into the anxiety group (SAS score≥50 points) and the non-anxiety group (SAS score<50 points). The methods of delivery, labor time and pregnancy outcome of the two groups of pregnant women were collected. Results Among 100 parturients, 27 cases had anxiety symptoms during pregnancy, accounting for 27.00%; the proportion of pregnant women in the anxiety group who chose natural vaginal delivery was 29.63% (8/27), which was significantly lower than 76.71% (56/73) in the non-anxiety group (P＜0.05); the incidence of postpartum hemorrhage, premature rupture of membranes, fetal distress and infection in the anxiety group (25.93%, 37.04%, 25.93%, and 25.93%) was significantly higher than that of the non-anxiety group (4.11%, 2.74%, 2.74%, and 1.37%) (P＜0.05); the first, second, and third stages of labor of pregnant women with natural childbirth in the anxiety group were significantly longer than those in the non-anxiety group (P＜0.05). Conclusion The way of delivery, delivery process, and pregnancy outcome of parturients are all affected by anxiety during pregnancy. Clinical interventions should be developed to relieve the anxiety of parturients during pregnancy and help improve pregnancy outcome.
2021 Vol. 28 (5): 409-412 [Abstract] ( 54 ) HTML (1 KB)  PDF (959 KB)  ( 169 )
413 Analysis on the use of narcotic drugs in outpatients of a tertiary hospital in 2020
Wang Zhenzhen, Li Yan, Lü Guangyao, Hu Limin, Wang Bin
DOI: 10.3969/j.issn.1006-5253.2021.05.007
Objective To analyze the use of narcotic drugs in outpatient pharmacy of a tertiary hospital in 2020, and to provide clinical reference for economic and rational drug use. Methods Totally 1 910 anesthesia prescriptions in the outpatient pharmacy of the hospital in 2020 were collected, and the consumption sum, defined daily dose (DDD), defined daily dose system (DDDs), daily dose cost (DDc), and order ratio (b/a) were statistically analyzed. Results The consumption sum of Oxycodone hydrochloride sustained-release tablets (10mg) was the highest, followed by oxycodone hydrochloride sustained-release tablets (40 mg); the DDDs of Oxycodone hydrochloride sustained-release tablets (10mg) was the highest, followed by fentanyl transdermal patch. Oxycodone hydrochloride sustained release tablets (40 mg) had the highest daily cost, followed by fentanyl transdermal patch; the order ratio of fentanyl transdermal patch was the largest, b/a=2, and the ranking ratio of other narcotic drugs (b/a) was close to 1. Conclusion The use of narcotic drugs in the outpatient department of the hospital is generally reasonable, but the use level of some drugs needs to be improved.
2021 Vol. 28 (5): 413-415 [Abstract] ( 48 ) HTML (1 KB)  PDF (942 KB)  ( 127 )
416 Path analysis on the factors influencing hospitalization expenses of the patients undergoing hemorrhoidectomy
Xue Junjun, Wang Heng, Li Niannian
DOI: 10.3969/j.issn.1006-5253.2021.05.008
Objective To explore the factors influencing hospitalization expenses of the patients undergoing hemorrhoidectomy, and to provide a scientific basis for reasonable control of medical expenses and reduction of the patient′s family and socioeconomic burden. Methods The case information of 469 patients with hemorrhoidectomy in 6 countylevel public hospitals in Anhui Province was collected and path analysis method was used to study the factors influencing hospitalization expenses of the patients with hemorrhoidectomy. Results The average hospitalization days were (5.08±2.59) days, with a median of 5 days; the average hospitalization expenses were (4 632.86±2 212.18) CNY, with a median of 3 578.30 CNY. The path analysis equation model has good goodness of fit and high estimation accuracy (F1=181.727, P<0.001; F2=30.618, P<0.001; R2=0.734). The direct effect of hospitalization days was 0.383; operation costs and south Anhui directly affected hospitalization expenses with direct effects of 0.268 and 0.270; the total number of surgeons and assistants indirectly affected hospitalization expenses only through hospitalization days with indirect effect of 0.123; anesthesia costs, disease outcome, operation grades, and central Anhui directly affected hospitalization expenses, and indirectly affected hospitalization expenses through hospitalization days. The total effects were 0.535, -0.122, 0.318 and -0.484, respectively. Conclusion Anesthesia costs are the most important factor affecting hospitalization expenses of patients with hemorrhoidectomy. In order to reduce hospitalization expenses, it is necessary to take comprehensive measures, adjust the structure of hospitalization expenses, and effectively save medical and health resources, on the basis of shortening the number of invalid hospitalization days and reducing reasonably anesthesia costs.
2021 Vol. 28 (5): 416-419 [Abstract] ( 77 ) HTML (1 KB)  PDF (1020 KB)  ( 158 )
420 Analysis on the disease composition of inpatients with malignant tumor in secondary or above medical institutions in a city from 2017 to 2019
Liu Jiwei, Zhang Qihua
DOI: 10.3969/j.issn.1006-5253.2021.05.009
Objective To understand the basic situation of inpatients with malignant tumors in a city, and to provide scientific basis and effective measures for tumor prevention and treatment in this region. Methods  From the " Provincial Health Information Network Direct Report System", we obtained the first page information of inpatient medical records of secondary and above medical institutions in a city from 2017 to 2019. The main diagnoses of patients were screened according to the main diagnosis and the International Classification of Disease (ICD-10), and the patients whose first diagnosis was malignant tumor were classified and summarized and statistically analyzed. Results There were 154 149 inpatients with malignant tumors in this study, with a malefemale ratio of 1.41:1. The average age of patients with malignant tumors was 61.74±13.56 years old, and the group of 60 to 74 years old accounted for the largest number of inpatients with malignant tumors (46.92%). The top five malignancies were digestive organ malignancies (31.26%), respiratory and thoracic organ malignancies (19.81%), lymphatic, hematopoietic and related tissue malignancies (14.95%), breast malignancies (8.34%) and male reproductive organ malignancies (7.63%). The number of inpatients accounted for 81.98% of all discharged patients. Conclusion The 60-74-year-old group and men are the key population for malignant tumor prevention and treatment in the city; malignant tumors of the digestive organs are the key diseases for prevention and treatment.
2021 Vol. 28 (5): 420-425 [Abstract] ( 57 ) HTML (1 KB)  PDF (913 KB)  ( 95 )
426 Study on the standard hospitalization cost of insurance patients with digestive system based on diagnosis related groups
Zhang Hongcheng, Li Shengli, Xu kai
DOI: 10.3969/j.issn.1006-5253.2021.05.010
Objective To provide a reference for better promoting the application of DRGs in medical insurance management, through the decision tree analysis of the standard hospitalization expenses of medical insurance patients in Xuzhou city. Methods The data were collected from a tertiary hospital of medical insurance inpatients with digestive system diseases in Xuzhou city from January 1, 2018 to June 30, 2019. Chi-squared Automatic Interaction Detector methods were used for classification and combination. Results Totally 4675 inpatients were enrolled and were divided into 21 DRGs groups. Conclusion In the process of formulating the standard hospitalization expenses of patients with medical insurance, government departments or medical insurance related institutions should appropriately use decision tree technology, which has a good methodological guidance.
2021 Vol. 28 (5): 426-428 [Abstract] ( 71 ) HTML (1 KB)  PDF (941 KB)  ( 169 )
429 Influencing factors of super long hospitalization days in an infectious disease hospital
Zhang Haidong, Li Yumei, Wu Junxia
DOI: 10.3969/j.issn.1006-5253.2021.05.011
Objective To analyze the distribution characteristics and influencing factors of patients with extralong hospitalization days in a tertiary infectious disease hospital in Nantong City, Jiangsu Province, and to explore measures to reduce the average hospital stay. Methods According to the disease classification ICD10 (A00-B99, J00-J99, K00-K93, Z00-Z99), the first page information of medical records of discharged patients in 2019 was collected, and logistic regression was performed on the relevant factors of patients who were hospitalized for more than 30 days. Results Among the 5 928 discharged patients, 878 were hospitalized for more than 30 days, accounting for 14.81% of all discharged patients in the infectious disease area. Among them, the proportion of male patients (67.43%) was higher than that of female patients (32.57%). Logistic regression analysis showed that age, disease classification, comorbidities, surgical operation, the difficult and critically ill, and antibiotic use were influencing factors for extremely long hospital days(P<0.05). Conclusion The hospital management department should focus on the management and monitoring of factors that affect the length of hospital stay in the infectious disease area, and establish standardized treatment plans according to disease types, improve medical standards, optimize medical resources, shorten the number of hospital stays, and achieve a winwin situation for patients and hospitals.
2021 Vol. 28 (5): 429-432 [Abstract] ( 82 ) HTML (1 KB)  PDF (891 KB)  ( 267 )
433 Analysis of inpatient deaths in a tertiary comprehensive hospital from 2010 to 2019
Liu Bing, Sun Jianhua
DOI: 10.3969/j.issn.1006-5253.2021.05.012
Objective To investigate the cause of death of inpatients in a tertiary comprehensive hospital in western Beijing and to provide reference for disease prevention and hospital management. Methods Patients who died in hospital from 2010 to 2019 were searched through the hospital electronic medical record information system, and the main causes of death were classified according to ICD-10 principles of international classification of Diseases. SPSS 26.0 software was used for statistical analysis. Results From 2010 to 2019, 269 727 inpatients were hospitalized, among which 7 202 died. The average age of death was (75.02±12.92) years old, and the ratio of men to women was 1.5∶1. The number of deaths varied in different seasons, with winter the most, accounting for 26.7%. The top three causes of death were malignant tumor, respiratory disease and circulatory system disease, accounting for 89.4% of all deaths. Malignant tumors ranked first among the causes of death, and the top 3 diseases were bronchial and lung malignant tumors, colorectal malignant tumors, and gastric malignant tumors. Conclusion More attention should be paid to the prevention and treatment of chronic diseases among the elderly, especially to the physical and mental health of men. Strengthening health promotion at the turn of the season could prevent disease. Malignant tumors and diseases of the respiratory and circulatory systems are still the main causes of death. Hospital administrators should strengthen the discipline construction of cardiovascular and cerebrovascular diseases and tumors.
2021 Vol. 28 (5): 433-437 [Abstract] ( 55 ) HTML (1 KB)  PDF (959 KB)  ( 118 )
438 Research on the status quo of medical record quality and the influencing factors of unqualified rate in a hospital
Yin Yuhua, Wu Huatun, Zhu Jianqian
DOI: 10.3969/j.issn.1006-5253.2021.05.013
Objective To study the current status of hospital medical record quality and the influencing factors of unqualified rate, explore measures to improve the medical record quality, and provide a theoretical basis for the hospital to improve the medical record quality. Methods A stratified random sampling method was used to sample 997 medical records from January to December 2020 in a tertiary general hospital in Hangzhou. SPSS 21.0 was used to analyze the data, and chisquare test and logistics regression analysis were used to analyze the influencing factors of the unqualified rate of medical records. Results The unqualified rate of medical records in the hospital was 11.93%, and the top three defective rates of medical records were the course records (33.00%), the admission records (31.62%), and the first page of the medical records (23.20%). The risk of unqualified medical records in the surgery department (OR=32.475, P＜0.001) and in the department of obstetrics and gynecology (OR=17.428, P＜0.001) was higher than that in the internal medicine department, and the risk of unqualified medical records in other departments was lower than that in the internal medicine department (OR=0.028, P＜0.001 ). Patients hospitalized for more than eight days had a higher risk of unqualified medical records (OR=24.267, P＜0.001), the risk of unqualified medical records with surgery/operations was higher than that without surgery/operations (OR=0.176, P＜0.001), the risk of unqualified medical records for rescue and difficult/death cases was higher than that for without rescue or difficult/death cases (OR=0.011, P<0.001), the risk of unqualified medical records for nonsingle disease management was higher than that for single disease management (OR=11.128, P＜0.001), and the risk of unqualified medical records of non-clinical path management was higher than that of clinical path management medical records (OR=13.840, P＜0.001). Conclusion The qualification rate of medical records needs to be further improved. The quality control of key departments and key medical records should be strengthened in terms of the quality control of medical records, to further promote the management of single disease and clinical pathways, and improve the quality of medical record writing.
2021 Vol. 28 (5): 438-442 [Abstract] ( 68 ) HTML (1 KB)  PDF (898 KB)  ( 144 )
443 Current situation of the ventilator-related data filling in the first page of the medical records in a tertiary hospital
Guo Shunping, Wang Mingxia, Ye Shiyue
DOI: 10.3969/j.issn.1006-5253.2021.05.014
Objective To understand the defects of breathing machine use time and related operation name filled in the medical record front page, and put forward improvement suggestions, so as to lay a solid foundation for the performance appraisal and DRG payment reform of public hospitals. Methods Totally 729 first pages of discharge medical records involving ventilator use time and corresponding operation name in a tertiary hospital from January 1, 2021 to May 31, 2021 were selected. The medical records were consulted one by one, and the filling in of ventilator use time and relevant operation name of clinicians and the coding of ventilator operation name of coders were analyzed. The defects were classified and statistically analyzed. Results The defect rates of ventilator use time, ventilator operation name and ventilator operation code were 20.03%, 59.40% and 55.42% respectively; the defects of ventilator use time were mainly wrong filling and over filling, accounting for 48.63% and 43.15% respectively; the filling defect of ventilator operation name was mainly missing, accounting for 67.21%; the coding defects of ventilator operation were mainly missing coding and wrong coding, accounting for 50.99% and 33.42% respectively.Conclusion Strengthening the training of clinicians and coders, establishing a four-level quality control mechanism for data reporting, and realizing the information management of the first page of medical records, can improve the accuracy and integrity of ventilator use data on the first page of medical records.
2021 Vol. 28 (5): 443-446 [Abstract] ( 65 ) HTML (1 KB)  PDF (887 KB)  ( 187 )
447 Influencing factors of delayed filing of medical records in the internal medicine department
Gu Yuting, Weng Jun, Peng Zhigang
DOI: 10.3969/j.issn.1006-5253.2021.05.015
Objective To explore the influencing factors of delayed filing of medical records, and to provide countermeasures for improving the filing rate of medical records within 7 working days. Methods The medical record filing data in the fourth quarter of each year from 2019 to 2020 in a hospital were collected, and the influencing factors were screened by logistic regression analysis. Results Logistic regression analysis showed that the protective factors of delayed filing of medical records were refined medical record management policies (OR=0.341) and moderate number of inpatients discharged by the attending physician per month (OR>21-44=0.371). Risk factors were transfer of departments (OR=1.901), readmission (OR=1.337), operation (OR=1.737), medical insurance of diagnosisintervention packet (OR=1.542), month with long holidays (OR=1.864), great number of inpatients discharged by the attending physician per month (OR>44=1.743), case classification (ORurgent=2.669, ORintractable=1.809, ORcritical=2.487) and longer length of stay (OR>5-12 d=1.659; OR>12 d=2.038). Conclusion Delayed filing of medical records is affected by many factors. Carrying out refined medical record management policies, regulating appropriate workload of attending physicians and focusing on the management of medical records with delayed filing risk factors, can effectively improve the filing rate of medical records within 7 working days.
2021 Vol. 28 (5): 447-451 [Abstract] ( 58 ) HTML (1 KB)  PDF (903 KB)  ( 132 )
452 Defect analysis on the first page of ambiguous medical records in a hospital in Guangzhou
Liu Sha, Liu Junfeng
DOI: 10.3969/j.issn.1006-5253.2021.05.016
Objective To find out defects of the first page of medical records, and improve the inclusion rate and accuracy rate of medical records by analyzing the ambiguous (QY) medical records in the DRGs system.Methods Parts of QY medical records from a hospital in Guangzhou in 2019 were selected to evaluate the defects of medical records from the following aspects: whether the main diagnostic codes were correct, whether the surgical operation codes were correct, whether the main clinical diagnosis was correct, whether the other diagnoses were correctly filled in clinically, whether the surgical procedures were correctly filled in clinically, and whether there were input errors. Results Totally 164 QY medical records were selfexamined, with 73 errors and 59 defective medical records. The error rate of the main diagnosis code was 9.15%, the error rate of the surgical operation code was 6.10%, the error rate of the clinician′s main diagnosis was 6.10%, the error rate of the clinical omission of other diagnosis was 10.37%, the error rate of the clinical operation was 2.44%, and the error rate of the input was 10.37%. The causes of QY medical record included: the defect of the clinician′s main diagnosis/operation filling, the coding error of the main diagnosis/operation, and the incorrect input. Conclusion Regular analysis of QY medical records can help medical record information managers find possible defects in the quality of home page data and normalized training for physicians and coders can improve the enrollment rate of medical records and the quality of home page data of inpatient medical records.
2021 Vol. 28 (5): 452-455 [Abstract] ( 64 ) HTML (1 KB)  PDF (951 KB)  ( 117 )
456 Comprehensive evaluation of DRG performance management based on combination weight and grey relation model
Jiang Shengjie
DOI: 10.3969/j.issn.1006-5253.2021.05.017
Objective To establish an index system with DRG performance management to comprehensively evaluate the medical service performance of tertiary maternity hospitals in Zhejiang Province in 2019, and to analyze the existing problems of DRG performance management in a maternity hospital. Methods An index evaluation system with DRG performance management was established by combining AHP and entropy weight method. A grey correlation model was used to comprehensively evaluate DRG performances of 15 tertiary maternity and child hospitals in the province. Results The maternity hospital in Hangzhou ranked high comprehensively in the province, the score of the CMI value was high, and the level and ability of diagnosis and treatment of medical services were high. However, the hospitalization cost, the average medicine cost, and the material consumption were higher than those in other hospitals, and the hospital readmission rate was higher than the average level of the entire province, which affected the promotion of its comprehensive evaluation in the whole province. Conclusion The establishment of the index evaluation system by using the combination weight can fully reflect the importance of the index and the subjective will of the decision-maker, and has certain scientificity and applicability. It is suggested to adjust hospitalization cost results, establish medical cost monitoring, reduce drug operating expenses, and conduct real-time monitoring of readmission rate, eliminate the decomposition of hospitalization times, and reduce readmission rate on the premise of ensuring efficacy.
2021 Vol. 28 (5): 456-461 [Abstract] ( 84 ) HTML (1 KB)  PDF (991 KB)  ( 131 )
462 Improvement and discussion of hospital quality management based on performance evaluation of tertiary public hospitals
Duan Shaohua, Zhang Xia, Yang Huili, Meng Wentao
DOI: 10.3969/j.issn.1006-5253.2021.05.018
Since 2019, tertiary public hospitals across the country have carried out performance appraisal. Under the new situation of medical reform, how to improve the quality management level is a challenge to the hospital. This paper makes a comprehensive analysis on the relationship between performance appraisal and quality management of tertiary public hospitals and its impact on quality management. And it discusses the strategies to improve the performance assessment of tertiary public hospitals through continuous improvement and prospective management by taking the performance assessment policy of tertiary public hospitals as the work guide, perfecting the quality management system, establishing the quality management database, realizing information management, playing the role of quality control, and improving the hospital performance assessment results through continuous improvement and prospective management.
2021 Vol. 28 (5): 462-466 [Abstract] ( 68 ) HTML (1 KB)  PDF (1424 KB)  ( 615 )
467 Methodological exploration of constructing colon cancer specific disease cohort based on hospital informatization
Zhu Jingjing, Yin Ruihua, Ge Chenyang, Hu Bin, Wang Xiaohong,Shan Qian,He Guobin, Zheng Hongjuan, Ling Lixian, Fu Jianfei
DOI: 10.3969/j.issn.1006-5253.2021.05.019
Objective International Classification of Diseases(ICD-10) homepage coding system and other information systems were used to establish a colon cancer database, and the credibility of the cohort was verified through survival analysis. Methods Patients with colon cancer admitted to the hospital between January 2013 and December 2019 were extracted by ID numbers from the ICD-10 homepage coding system, the cancer reporting system database and the pathology database, respectively. The three databases were then cleaned and merged to create the colon cancer cohort. The pathological staging of the colon cancer cohort was performed to analyze the prognosis of colon cancer.Results Totally 1 148 patients with colon cancer were screened and obtained from ICD-10 home page coding system; 1 060 colon cancer patients were screened and enrolled from the pathological database, which was combined with ICD-10 home page coding system database to form a pathological record database; finally, a cohort of 581 colon cancer patients was generated by intersections with 831 colon cancer patients screened from the cancer report card database. A survival analysis of the cohort found that the center's colon cancer database matched the results of other studies.Conclusion It is credible to establish a tumor cohort by using the existing ICD-10 homepage coding system, the pathology system of the hospital and the cancer reporting and follow-up system established by the center for disease control and prevention. And expanding this model would help build colon cancer databases nationwide.
2021 Vol. 28 (5): 467-471 [Abstract] ( 56 ) HTML (1 KB)  PDF (1146 KB)  ( 194 )
472 Construction and application of breast cancer database based on cloud platform
Xue Li, Chen Caiping, Han Chao, Xing Dan, Lu Xiang
DOI: 10.3969/j.issn.1006-5253.2021.05.020
Objective The treatment and overall management of breast cancer is a longterm process, and the use of a computer database system to manage patients can help improve work efficiency. Based on the breast cancer database from the cloud platform, this article discussed its design and application experience.  Methods The system adopted browser/server architecture, the server adopted one cloud server from Alibaba cloud and one cloud server from Tencent cloud, the database software adopted MySQL, and the server-side scripting language adopted PHP. The coders established a variety of tables in the database to store relevant data, and wrote dynamic webpage code to achieve functions like data entry, modification, and database management. Results A breast cancer database management system based on cloud platform was successfully established (computer software copyright registration No.: 2021SR0484007). The main database was run by the Alibaba cloud server and the backup database was run by the Tencent cloud server. The two databases were synchronized in real-time via the Internet. Thirteen patient-related data tables, 1 user permission data table, 6 database log tables, and 4 scientific research data tables were established. And 118 software code files were created, with a total of more than 20000 lines of code. By February 24, 2021, data of 2 763 breast cancer patients were stored. The database runs stably and meets the design requirements. Conclusion The breast cancer database management system based on cloud platform meets the design requirements, and the system runs stably with high security.
2021 Vol. 28 (5): 472-476 [Abstract] ( 52 ) HTML (1 KB)  PDF (1739 KB)  ( 289 )
477 Screening effect of DRGs detection software on the first page of medical records
Liu Jiyang, Shen Yang
DOI: 10.3969/j.issn.1006-5253.2021.05.021
Objective To audit the quality of the first page of hospital medical records by using DRGs hospital analysis and inspection X software, verify the feedback errors by manual inspection, and compare and analyze the screening effect of DRGs testing software on the first page of medical records.Methods The first page data of electronic medical records in the first quarter of 2020, which had not passed quality control, were collected and sorted out, and imported into DRGs grouping system data format for processing. X software was used for error detection and screening, and 200 medical records were sampled randomly. In addition, the audit team set up by the hospital verified 200 sampled wrong medical records one by one, summarized, compared and analyzed the causes of errors. Results Among the 200 wrong medical records screened by X software, 4 were not included in the group. Among the 196 wrong medical records, there were 35 non-coding errors and 161 coding errors. The audit team checked the front pages of the 200 wrong medical records, and found that 7 cases were not included in the group, 30 cases were non-coding errors and 163 cases were coding errors. X software can play an active role in the quality screening of the front pages of medical records, and most of the errors on the front pages of 200 medical records are consistent with the actual situation, but there are still some defects. Conclusion DRGs hospital analysis and testing software can play an active role in screening, and its effect still needs to be constantly updated and improved in practice.
2021 Vol. 28 (5): 477-480 [Abstract] ( 65 ) HTML (1 KB)  PDF (890 KB)  ( 89 )
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