25 February 2022, Volume 29 Issue 1

    

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  Status and influencing factors of discrimination perception among patients with chronic hepatitis B virus infection

  Sun Lei, Yu Nannan, Hou Xuna, Zheng Jisheng, Gong Shuping, Zhao xiaomin

  journal1. 2022, 29(1): 1-6. https://doi.org/10.3969/j.issn.1006-5253.2022.01.001

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  Objective To explore the current status of discrimination perception and its influencing factors among patients with chronic hepatitis B virus infection, and to provide a theoretical basis for clinical medical workers to formulate intervention measures. Methods A convenience sampling method was used to select 252 people with chronic hepatitis B virus infection in a certain infectious disease hospital in a city as the research objects. The General Conditions Questionnaire, the Discrimination in Chronic Hepatitis B Virus Infection Scale and the Social Support Rating Scale were used for the survey. Results The total score of discrimination perception among people with chronic hepatitis B virus infection was 67.46±18.65. Gender (b=5.802), education level (b=2.877), self-evaluation of health status (b=-2.918), and social support (b=-0.756) were influencing factors on the discrimination perception among people with chronic hepatitis B virus infection (P<0.05). Conclusion The overall discrimination perception of people with chronic hepatitis B virus infection was at a moderate level. Clinical medical staff should focus on patients who are women, with high education level, with low health self-ratings, and low social support, and strengthen health education and social support of patients to improve the discrimination perceived by patients with chronic hepatitis B virus.
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  Standardized evaluation of prevention and control process for birth defect in Hunan Province in 2019

  Zhou Jingtao, Li Yingzi, Hua Junjie, Ning Peishan, Hu Guoqing

  journal1. 2022, 29(1): 7-13. https://doi.org/10.3969/j.issn.1006-5253.2022.01.002

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  Objective To evaluate the implementation status of standardized evaluation of prevention and control process for birth defect in Hunan Province, and to provide basis for promoting the standardization of prevention and control of birth defect. Methods A self-developed standardized evaluation questionnaire for the prevention and treatment of birth defects was used to evaluate the standardization of the prevention and control process of birth defects in 123 districts/counties of 14 cities /prefectures in Hunan Province in 2019. The standardization of prevention and control process for birth defect includes 9 second-level indicators and 49 third-level indicators. The proportion was used to reflect the development of each index, and the standardized comprehensive score of prevention and control process for birth defect was calculated to reflect the degree of standardization of prevention and control process for birth defect in Hunan Province. Results The median score of standardized comprehensive evaluation of prevention process for birth defect in 123 districts and counties of Hunan province was 89.1 (IQR=6.7), and the scores of 7.3% of districts and counties were below 80. And 85.7% of the projects related to the prevention and control of birth defects in 123 districts and counties, were carried out at least 90%, and the free pre-marital medical examination services, the establishment of health management files, free pre-pregnancy healthy birth examination services and prenatal screening services reached 100%. The median coverage ratio of prevention and treatment measures was 95%, accounting for 70.97% (22/31), among which, the proportion of healthy birth consultation among key groups, and the pregnancy termination rate of pregnant women with unfavorable fertility and high risk varied greatly between counties (IQR=72.8%, 97.6%). There were also differences in the implementation of different indicators, and only 4.9% of people of childbearing age and infants in iodine-deficient areas were given scientific iodine supplements. Conclusion At present, the prevention and control process of birth defects in Hunan province is relatively standardized, but there are still some differences in the development process of different districts and counties and different prevention and control measures. In the future, targeted measures should be taken for weak links and regions to promote the standardization of the prevention and control process of birth defects in Hunan Province.
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  Death from malignant tumors in Chinese urban residents from 2015 to 2019

  Li Rui, Wang Qi, Liu Haixia, Hu Naibao, Wei Fei

  journal1. 2022, 29(1): 14-17. https://doi.org/10.3969/j.issn.1006-5253.2022.01.003

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  Objective To analyze the mortality characteristics and trends of malignant tumors in Chinese urban residents from 2015 to 2019, and to provide evidence for the prevention and treatment of malignant tumors. Methods SPSS25.0 software was used to analyze the death data of urban residents with malignant tumors from 2015 to 2019 in China Health and Family Planning Statistical Yearbook and China Cause of Death Surveillance Data Set, and the number of deaths, death rate, order of death causes were selected as the characteristic indicators of death. Results From 2015 to 2019, the average annual mortality rate of malignant tumors was 162.36/100 000, and the mortality rate of males was higher than that of females. The top five leading causes of death were lung cancer, liver cancer, stomach cancer, colorectal cancer and esophageal cancer. The mortality rate of colorectal cancer was on the rise, while the mortality rate of the other four malignant tumors was on the decline. Conclusion In recent five years, the mortality rate of malignant tumors in urban residents in China has not changed much. Lung cancer and digestive system malignant tumors are still the main diseases that endanger the life and health of residents. Early screening of malignant tumors should be strengthened to effectively prevent and control the harm of malignant tumors to human health.
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  Deep venous thrombosis in invasive mechanically ventilated patients: incidence and risk factors

  Lou Xiaohua, Zhang Bingwen, Jing Daoyuan

  journal1. 2022, 29(1): 18-24. https://doi.org/10.3969/j.issn.1006-5253.2022.01.004

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  Objective To explore the incidence and risk factors of deep vein thrombosis(DVT) in invasive mechanically ventilated patients.Methods Clinical data of mechanical ventilation patients admitted to the Emergency Care Unit of Jinhua Hospital Affiliated to Zhejiang University School of Medicine from January 2019 to December 2019 were collected, and the preventive measures of venous thrombosis, incidence of deep venous thrombosis, onset time, length of ICU stay, and 90-day all-cause mortality rate of the patients were recorded. Multivariate logistic regression analysis was used to assess the independent risk factors for DVT. Results Two hundred mechanically ventilated patients with a mean age of (59.3±16.8) years old, a median APACHEⅡ score of 19(14,24), a median Caprini 2009 score of 8(6,10), a median ICU length of stay of 9 (5,18) days, and a 90-day all-cause mortality rate of 24.5%. The incidence of DVT was 23.0%, and the median time of onset was 7(4,13) days after ICU admission. Multivariate Logistic regression analysis showed that patient′s age (OR=1.029, 95% CI: 1.005-1.055), and length of ICU stay (OR=1.057, 95% CI: 1.033-1.082) were independent risk factors for the development of DVT in ICU patients. Conclusion Patients receiving mechanical ventilation in the ICU are at high risk for DVT, and patients with DVT had significantly longer ICU stays. Independent risk factors for DVT were age and length of ICU stay.
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  Prediction of hospital outpatient visits based on time series model

  Sang Quanhong, Xu Peiwen

  journal1. 2022, 29(1): 25-28. https://doi.org/10.3969/j.issn.1006-5253.2022.01.005

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  Objective To analyze and predict the number of outpatients in a hospital in the future, so as to provide data and theoretical basis for effective allocation of medical resources, formulation of medical work plan and scientific decision-making. Methods The prophet time series prediction model is adopted and the statistical data are imported to predict the number of outpatients per month in the future, and the actual data in 2019 are compared to verify the accuracy and practicability of the model. Results The seasonal variation of outpatient visits takes one year as a cycle, and the variation trend is roughly the same. The characteristics of variation with seasonal variation have obvious regularity. Conclusion The prophet algorithm based on time series is used for the prediction of hospital outpatient volume. The method is simple, intuitive and the result is relatively accurate, so it can provide the basis for hospital leaders to make medical work plans and scientific decisions.
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  Research on the incentive effect of hospitalization expenses of lung cancer patients based on factor analysis

  Wang Zhouqiang, Wu Xiaoqin

  journal1. 2022, 29(1): 29-31. https://doi.org/10.3969/j.issn.1006-5253.2022.01.006

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  Objective To analyze the changes in the cost structure of lung cancer inpatients and the factors that affect the cost hospitalization, and provide a reference for the hospital to reasonably control the hospitalization costs. Methods The data of the first page of the medical records of discharged patients diagnosed with lung cancer from 2015 to 2018 in a tertiary hospital of a city were selected, and the hospitalization expenses of the patients were statistically analyzed after data cleaning. Results The average hospitalization cost of 7 711 lung cancer patients was 26 557.53 yuan. The average cost of the top three categories was 9 888.85 yuan for comprehensive medical services accounting for 37.24%, 6 659.19 yuan for medicine accounting for 25.07%, and 3 865.76 yuan for diagnosis and treatment accounting for 14.56%. Surgical consumables factor, medicine service factor, auxiliary diagnostic factor and other cost factors were common factors affecting the hospitalization cost of lung cancer patients. Conclusion The hospitalization expenses of lung cancer patients are showing an upward trend, and the proportion of medicine is decreasing year by year. The hospital can reduce the medical expenses of lung cancer patients by controlling the cost of surgery, consumables and medicine.
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  Influencing factors of hospitalization expenses of serious illness based on quantile regression

  Liu Pei, Zhong Shiyang, Guo Wei, Lü Yipeng, Tang Yuanjie

  journal1. 2022, 29(1): 32-37. https://doi.org/10.3969/j.issn.1006-5253.2022.01.007

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  Objective To analyze the composition of hospitalization expenses, explore the related influencing factors and provide policy suggestions. Methods Inpatient data of medical expenses in a tertiary hospital in Yangzhou City, Jiangsu Province from 2016 to 2019 were used, and Stata 16 software was used to analyze the composition of inpatient medical expenses. On the basis of single factor analysis, a quantile regression model of inpatient medical expenses was constructed. Results Mean hospitalization cost of serious illness was 34 860 yuan, and the proportion of drug cost decreased by 8.94% over four years. Univariate analysis showed that the influencing factors of hospitalization expenses included age (χ²=63.467, P<0.001), marital status (Z=-4.305, P<0.001), source of patients (Z=-10.555, P<0.001), identity (Z=-4.207, P<0.001), way of payment (Z=-14.287, P<0.001), hospitalization days (χ²=1 930.540, P<0.001), operation (Z=-17.149，P<0.001), curative effects (χ²=49.104，P<0.001) and hospitalization times (χ²=111.937, P<0.001). The results of quantile regression model showed that way of payment, hospitalization expenses, operation, and hospitalized times had an impact on different quantile points of hospitalization expenses. Conclusion Compared with the traditional regression model, quantile regression model is more robust. Increasing the coverage of medical insurance, and carrying out health education can not only promote the utilization rate of medical insurance, but also reduce the medical expenses.
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  Survey on major single diseases in urology of 31 hospitals in Chengdu

  Xu He, Cao Min, Zhuo Hui

  journal1. 2022, 29(1): 38-41. https://doi.org/10.3969/j.issn.1006-5253.2022.01.008

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  Objective To analyze the implementation status of two single diseases in urology of 31 public hospitals in Chengdu, so as to provide targeted suggestions for the implementation of single diseases in urology. Methods The medical service data of Urology of 31 hospitals in Chengdu in 2019 and the data related to the diagnosis and treatment of single disease of ureteral calculi and benign prostatic hyperplasia were collected through questionnaire survey for descriptive analysis. Results Patients with ureteral calculi and benign prostatic hyperplasia accounted for 35.81% and 10.66% of urinary inpatients respectively. Ureteroscopic lithotripsy was unsuitable for day surgery in 65.00% of hospitals, and transurethral resection of prostate was considered unsuitable for day surgery in 96.00% of hospitals. Conclusion It is suggested to improve the medical technology level and medical equipment of urology in Chengdu. On the premise of ensuring medical quality and medical safety, transurethral holmium laser lithotripsy for ureteral calculi and transurethral resection of prostate should be carried out as day surgery. It is suggested to imply a new single disease medical insurance payment method according to disease diagnosis related groups (DRGs).
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  Research on DRGs grouping for patients with chronic obstructive pulmonary disease based on quantile regression and decision tree model

  Wu Li, Lü Zhijie, Lu Hanti, Huang Sijia, Zhou Penglei

  journal1. 2022, 29(1): 42-46. https://doi.org/10.3969/j.issn.1006-5253.2022.01.009

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  Objective To explore the DRGs grouping and hospitalization cost standard for patients with chronic obstructive pulmonary disease (COPD), and to provide support for relevant hospital managers to formulate targeted control measures and improve the system.Methods The first page data of COPD patients′ medical records from a tertiary hospital from 2018 to 2020 were selected. Multiple linear regression, quantile regression and decision tree model were used for case combination analysis.Results Totally 1 929 patients with COPD were included in this study. The results of multiple linear regression model and quantile regression model showed that the hospitalization days, age, payment method, source of patients and complications/comorbidities were the main factors influencing the hospitalization cost of patients with COPD (P<0.05). Taking hospitalization days as the influence variable, and age, complications/comorbidities, source of patients and payment method as 4 classification nodes into decision tree model, 5 DRGs combinations were formed with the corresponding standard of hospital expenses and the weight of disease types. The standard hospitalization expenses of each group were 17 814.40 yuan, 12 138.80 yuan, 10 402.07 yuan, 10 144.50 yuan and 7 954.49 yuan, and the disease weight coefficients were 1.36, 0.93, 0.79, 0.77 and 0.61 respectively.Conclusion It is beneficial to control the inpatient cost of this disease, reduce the economic burden of patients, and provide the basis for the reform of medical expense payment mode by establishing the standard of inpatient cost and the weight of disease.
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  Analysis on the influencing factors of inpatient expenses for acute myocardial infarction in a tertiary hospital from 2018 to 2020

  Shang Di, Zou Fang

  journal1. 2022, 29(1): 47-50. https://doi.org/10.3969/j.issn.1006-5253.2022.01.010

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  Objective To find out the factors affecting the hospitalization costs, and to provide the basis for the development of reasonable payment standards, through the analysis of 3 732 cases of acute myocardial infarction patients from 2018 to 2020 in a tertiary hospital of a certain city.Methods Descriptive statistical analysis, univariate analysis and multiple regression analysis were used to find out the variables with statistical significance (P<0.05).Results The hospitalization cost of AMI was on the rise from 2018 to 2020, and increased by 9.15% in 2020 compared with that in 2018. The average hospitalization cost was 43 178.58 yuan, and the diagnosis cost accounted for 50.73%, which was the highest among the hospitalization cost components. Drug costs followed, accounting for 23.97%; operation cost accounted for 12.22%; the fourth was the cost of treatment, accounting for 9.81%; the lowest proportion was other expenses, accounting for 7.14%. Age, length of stay, department of discharge, operation, operation method and mode of discharge had influence on hospitalization expenses, among which operations and length of stay had the greatest influence.Conclusion It is necessary to establish and perfect the control mechanism of single disease and constantly improve the construction of chest pain center, to take value oriented medical treatment as the guidance, with reasonable examination and rational drug use, shorten the average hospital stay of patients, and reduce the economic burden of patients.
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  Application case analysis of R coding in ICD-10

  Zhang Rui, Yang Fan

  journal1. 2022, 29(1): 51-53. https://doi.org/10.3969/j.issn.1006-5253.2022.01.011

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  Objective To review the quality of disease coding with R code as the main diagnostic code in a hospital, summarize the error types, and select typical cases for analysis and discussion, in order to provide guarantee for improving the accuracy of disease coding and carrying out DRGs payment smoothly.Methods Four hundred and thirtyseven medical records with R code of discharged patients from October 1, 2021 to December 31, 2021 were extracted, and the medical records were consulted and reviewed one by one according to the international classification of diseases.Results There were 51 coding errors with an error rate of 11.7% among the 51 cases with R coding. The erroneous medical records were divided into 4 categories according to the error type, among which 58.8% (30/51) should be classified to other chapters, 31.4% (16/51) were wrong in the selection of major codes, 7.8% (4/51) missed the coding of disease cause or main treatment (4/51), and other errors accounted for 2.0% (1/51).Conclusion The main causes of R coding errors in the hospital are coders′ failure to consult medical records, blind compliance with doctors′ choice of main codes, and lack of medical knowledge and classification rules. In order to improve coding quality, coders need to improve their professional knowledge and strengthen coding quality control.
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  Analysis on the enrollment of DRGs in MDCQ group

  Wang Yuqin, Zhao Qinhua, Duan Congzhe, Lu Yao, Hu Junjun

  journal1. 2022, 29(1): 54-57. https://doi.org/10.3969/j.issn.1006-5253.2022.01.012

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  DRGs payment mode has gradually become the main payment mode of China′s medical and health system reform and medical insurance system reform, and also plays a guiding role in hospital performance evaluation. Referring to a DRGs data platform, this paper calculates the simulation data of DRGs grouping before and after correcting the coding errors of main diagnosis and/or main surgical operation categories found in the coding quality control process of a hospital. Cases related to MDCQ blood, hematopoietic organs, immune diseases and dysfunction group were analyzed to discuss the basis for modifying the diagnosis and surgical operation code, so as to reflect the impact of diagnosis and surgical operation on DRGs enrollment. Medical institutions should be encouraged to attach importance to the data of the first page of medical records, especially to recognize the importance of correct selection of doctors and correct coding of coders in diagnosis and surgery information, and finally improve the rationality of DRGs inclusion by improving the correct coding rate of the first page of medical records.  
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  Analysis on medical service efficiency in Shandong Province based on DEA-CCR model

  Wu Xiaojuan，Zhao Qingxiang，Qu Wei

  journal1. 2022, 29(1): 58-62. https://doi.org/10.3969/j.issn.1006-5253.2022.01.013

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  Objective To evaluate the efficiency of medical services in medical institutions in Shandong Province, and to provide reference for improving the utilization rate of health resources.Methods CCR model was used to evaluate the technical efficiency and scale efficiency of health resources of medical institutions in Shandong Province.Results The technical efficiency, pure technical efficiency, and scale efficiency of the medical resources in 17 cities in Shandong Province were 0.982, 0.988, and 0.993, respectively. Among them, cities with effective DEA accounted for 47.06%, and cities with unchanged profit scale accounted for 58.82%. The total allocation of health resources and the amount of medical services in Shandong Province have increased year by year, but the overall change of health service efficiency is not large.Conclusion The health service efficiency of medical institutions in Shandong Province is not balanced. It is necessary to take economic conditions, population and other factors into consideration and allocate health resources scientifically according to local conditions.
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  nvestigation and analysis of KAP status of clinical medical staff under the management of DRGs

  Wang Zunhui, Li Caixue

  journal1. 2022, 29(1): 63-68. https://doi.org/10.3969/j.issn.1006-5253.2022.01.014

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  Objective  To understand the KAP status of clinical medical staff under DRGs, and to provide reference for the operation efficiency of hospital DRGs.Methods A self-designed KAP questionnaire was used to investigate the clinical staff in a children′s hospital of Hangzhou, and the influencing factors of questionnaire scores were analyzed by t-test, single factor-analysis- of variance and multiple linear regression with the 25th version of SPSS.Results Two hundred and seventy-two people participated in the survey, including 107 doctors, 116 nurses and 49 medical technicians, with a median age of 32 (28,37) years old, and 183 people participated in the DRGs related knowledge training on the first page of medical records with an average total score (11.01±2.24). There were statistically significant differences in all variable groups except gender (Ｐ<0.05). The scoring rate of knowledge, attitude and practice were 27.55%, 71.45% and 71.22% respectively. There were significant differences (Ｐ<0.05) in knowledge score among different age, educational background, professional level, working years, training times and questionnaire filling time, and the score increased with the increase of variable value. There were statistical differences for raining times and educational background (Ｐ<0.05) on the total score in multivariate analysis. It was the primary factor affecting learning that there were too many DRG versions and concepts were difficult to understand, and most people want to learn via online video courses.Conclusion We should carry out targeted multichannel training, improve the scheme of performance distribution, and stimulate the subjective initiative of the personnel, so as to form correct beliefs, carry out positive practice, and promote the promotion and application of DRGs in hospitals.
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  Application of DRGs in performance evaluation of inpatient medical service in gastrointestinal surgery

  Liu Junfeng, Liu Sha, Xin Ziyi

  journal1. 2022, 29(1): 69-72. https://doi.org/10.3969/j.issn.1006-5253.2022.01.015

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  Objective To analyze the related indicators of DRGs in gastrointestinal surgery in a hospital in 2020, so as to provide data support for hospital performance evaluation and fine management.Methods The data of the first page of medical records of 6 570 inpatients in 3 wards of the gastrointestinal surgery department in a hospital from January 1, 2020 to December 31, 2020 and the feedback data of the DRGs platform were collected, and the comprehensive index method was used for data processing and evaluation.Results The comprehensive index of ward B was the highest, followed by ward A and ward C. The disease types in the gastrointestinal surgery mainly concentrated in RE19, GB23, GB15, GB25, GE15 and GR15 groups. These DRGs groups accounted for more than 80% of the cases in gastrointestinal surgery analysis, and the disease types in each ward were different. The time consumption index of gastrointestinal surgery was 0.50 and the cost consumption index was 1.29, which indicated that gastrointestinal surgery needed shorter time and higher cost to treat similar diseases.Conclusion DRGs indicators can be used to analyze the performance of medical services from multiple dimensions, and provide data support for hospital performance evaluation and refined management.
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  Ａnalysis of the current situation of nosocomial infection management in primary medical institutions in a county

  Zhong Jie, Dai Jiangying, Yu Tingting

  journal1. 2022, 29(1): 73-77. https://doi.org/10.3969/j.issn.1006-5253.2022.01.016

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  Objective To investigate and analyze the current situation of nosocomial infection management in primary medical institutions in a county.Methods Twentysix primary medical institutions (17 public hospitals and 9 private hospitals) were investigated by the questionnaire survey for statistical analysis.Results The organizational system of nosocomial infection management and the allocation of full-time nosocomial infection management and the management of medical waste were constantly improved and standardized. Related systems and measures of nosocomial infection management were partially divorced from reality, and performed incompletely. There was lack of effective targeted training, with incomplete coverage of training and poor results. Hand hygiene, disinfection and sterilization, safe injection, occupational exposure and other measures needed to be further strengthened. The risk awareness and the ability of differential diagnosis and monitoring about nosocomial infection were insufficient, and the relevant work was poorly carried out. Public hospitals were superior to private hospitals only in the aspects of ultraviolet lamp radiation intensity monitoring, heat sentinel and dental settings, but inferior to private hospitals in the aspect of risk assessment (P<0.05).Conclusion Strengthening the administrative supervision, making full use of the county level quality control center of nosocomial infection management, strengthening the methods of training education, enhancing the capacity-buil-ding of nosocomial infection monitoring and risk assessment and intervening measure, intensifying the enforcement of fundamental standard precautions, clearing the responsibilities of relevant departments, and bringing the results of nosocomial infection examination into performance appraisal system, can promote the sustainable development of nosocomial infection management.
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  Design of simple random sampling based on function of Excel or WPS

  Yan Yubing, Xu Hang, Chen Xiaoping

  journal1. 2022, 29(1): 78-80. https://doi.org/10.3969/j.issn.1006-5253.2022.01.017

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  Objective To develop a simple random sampling method suitable for researchers at all levels.Methods By using the inherent functions of rank (), rand (), vlookup () and if () of Excel and WPS softwares, the simple random sampling method is designed and the reusable sampling tool is customized.Results The simple random sampling method based on the function design of Excel or WPS can realize the simple random sampling of millions of research population in a few seconds. At the same time, it has the characteristics of simple design and use, short development time and reusability.Conclusion Compared with the sampling tool of Excel, which is only applicable to the data of digital population, the simple random sampling method based on the function design of Excel or WPS can not only realize the sampling of all character types, but also does not need to install add-on items, which is more suitable for health personnel at all levels.