25 October 2023, Volume 30 Issue 5

    

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  Clinical characteristics of sudden deafness with hypertension and the influencing factors of treatment efficacy

  Huang Shibin， Sheng Jian，Chen Xun， Gao Weimin，Zhang Xiangyi， Mi Wei

  journal1. 2023, 30(5): 321-329. https://doi.org/10.3969/j.issn.1006-5253.2023.05.001

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  Objective To analyze the relevant factors affecting the efficacy of patients with sudden sensorineural hearing loss accompanied by hypertension, and to provide reference basis for the prevention and treatment of sudden sensorineural hearing loss.Methods Clinical data of patients with sudden sensorineural hearing loss and hypertension admitted to a certain hospital in Jiaxing from 2019 to 2022 were collected to analyze the relationship between variables and treatment efficacy of patients with the logistic regression model.Results The majority of 165 cases with sudden deafness accompanied by hypertension were female, with the majority engaged in manual labor occupations. The highest incidence of the condition occurred in summer. The results of the univariate analysis indicate that the efficacy of treatment for patients is correlated with age, accompanying tinnitus, classification of sudden deafness, platelet count, and treatment method (P<0.05). The multivariate logistic regression model analysis shows that older age (OR=1.073, 95%CI: 1.023-1.125), high serum potassium (OR=9.693, 95%CI: 5.829-15.633), high thyroidstimulating hormone (OR=5.023, 95% CI: 1.833-13.764) are independent risk factors for ineffective treatment, while high platelet count (OR=0.872, 95%CI: 0.652-0.978) and comprehensive treatment with hyperbaric oxygen (OR=0.137, 95%CI: 0.056-0.339) are protective factors for effective treatment.Conclusion Sudden sensorineural hearing loss accompanied by hypertension has a higher rate of adverse prognosis, and various factors collectively influence the treatment outcome of patients with sudden sensorineural hearing loss accompanied by hypertension.
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  Analysis of day surgery in an eye hospital from 2018 to 2021

  Zhang Jing, Han Yanfeng, Zhou Jinyan, Wang Xiaoyun

  journal1. 2023, 30(5): 330-333. https://doi.org/10.3969/j.issn.1006-5253.2023.05.002

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  Objective To analyze the data of day surgery in an eye hospital, and to summarize the advantages of day surgery.Methods The medical records of 35 025 patients with day surgery in an eye hospital from July 2018 to December 2021 were retrospectively reviewed, including disease type, proportion in all surgery, average hospitalization days, hospitalization cost, and surgery cancellation rate.Results The disease types of day surgery increased year by year, and the top 5 diseases were lens disease, retinopathy, glaucoma, conjunctivopathy, and strabismus. The proportion of day surgery also increased year by year, reaching 81.62% by 2021. Day surgery shortened the average hospital stay by 1.26 days, and the average total cost reduced by 1 416.58 yuan. The surgery cancellation rate decreased year by year, and the average temporary cancellation rate was 1.09%.Conclusion Ophthalmic day surgery makes full use of medical resources to speed up the turnover of beds, has the advantages of short hospitalization time, safety, and low cost, which meet the needs of patients and their families. It is easy to write medical records in daytime, which improves the working efficiency of doctors. With the gradual improvement of medical technology, the number of diseases and operations carried out in day surgery will be increased, so as to promote the improvement of medical quality and service ability of the hospital.
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  Calculation of the complication index measurement for DIP payment based on decision tree for spinal stenosis

  Li Yunfeng，Chen Liya，Yang Yechun

  journal1. 2023, 30(5): 334-338. https://doi.org/10.3969/j.issn.1006-5253.2023.05.003

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  Objective To explore the standard cost subdivision scheme and complication index measurement (CCI) of DIP subgroup "spinal stenosis: lumbar interbody fusion, posterior approach", and to provide reference for the improvement of DIP payment scheme and policy formulation by the medical insurance department.Methods The home page data of 1 610 cases of spinal stenosis in a large tertiary hospital in Guangzhou from 2020 to 2022 were selected to screen the main complications of this group. The cost data were further fitted with decision tree model, DIP subgroups of different complications were established, and the complication index of each group was measured. Results The main complications in the spinal stenosis group were hypertension, type 2 diabetes, hyperuricemia and urinary system infection, which occurred in 20.31%, 10.37%, 5.16% and 4.35% cases, respectively. Quantile regression analysis showed that there were statistical differences in total hospitalization costs between the two groups with or without hypertension, type 2 diabetes, urinary tract infection or pneumonia (P<0.05). Four DIP subgroups with spinal stenosis were formed based on the decision tree model. The complication index of the subgroup with hypertension and urinary system infection was 1.04, that of the subgroup with type 2 diabetes was 1.08, and that of the subgroup with other complications was 0.98.Conclusion The complications of spinal stenosis are widely dispersed. The standard cost and complication index of spinal stenosis subdivision program are calculated by using decision tree model, which improves the accuracy of DIP payment and can provide reference for DIP to make subdivision program and improve the standard score database.
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  Investigation and analysis on the status of telemedicine informatization construction in medical institutions in China

  He Xianying, Li Chenchen, Sun Dongxu, Chu Yuntian, Cui Fangfang, Zhao Jie

  journal1. 2023, 30(5): 339-344. https://doi.org/10.3969/j.issn.1006-5253.2023.05.004

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  Objective To understand the current situation of telemedicine informatization construction in medical institutions in China, and provide suggestions for improving telemedicine services.Methods From October to November 2019, an online questionnaire survey was used to investigate the principals of telemedicine in 223 medical institutions. The survey contents included the basic information of the hospitals, telemedicine network construction, hardware equipment, software deployment and docking. Descriptive statistics were used for data analysis.Results The telemedicine networks of tertiary hospitals and secondary hospitals were dominated by private networks, accounting for 53.2% and 78.2%, respectively. The annual consultation volume of medical institutions using telemedicine network was higher than that of public Internet, and the difference between the two was statistically significant (Z=-2.273, P=0.023). The equipment of remote education recording and broadcasting were with the highest allocation rate in tertiary hospitals, accountig for 54.6%, and the remote ECG collection terminals were with the highest allocation rate in secondary hospitals, accounting for 46.4%. In addition, 38.7% of tertiary hospitals and 40.2% of secondary hospitals had connected their information systems with telemedicine systems. Conclusion Telemedicine is an important means to optimize the allocation of medical resources. It is necessary to further expand the coverage of telemedicine private network, promote the deployment of portable intelligent terminals, improve the construction of telemedicine information system, promote the interconnection of information systems, and ensure the quality and efficiency of telemedicine services.
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  Analysis of the current status and influencing factors of burnout among nurses in pediatric wards

  Ding Qingmei, Bi Lexuan, Liu Na, Fang Xiaoqing, Liu Yaxin, Ding Xuemei, Zhang Xiaoli

  journal1. 2023, 30(5): 345-352. https://doi.org/10.3969/j.issn.1006-5253.2023.05.005

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  Objective To investigate the current status of burnout among nurses in pediatric wards and analyze its contributing factors.Methods Pediatric ward nurses from 10 tertiary hospitals in Shandong Province were selected in groups using the convenience sampling method, and their questionnaires were surveyed using the General Data Questionnaire and the Maslach Burnout Scale.Results The total score of burnout among 335 nurses in the pediatric wards was (76.60±20.08), of which 220 (65.7%) nurses had burnout, 99 (29.6%) had mild burnout, 84 (25.1%) had moderate burnout, and 37 (11.0%) had high burnout. The results of optimal scale regression analysis showed that selfperceived health status, job satisfaction, establishment, job title, number of night shifts per week, leadership and family care, and pediatric working years were the main influencing factors of burnout among nurses in pediatric wards (P<0.05), among which selfperceived health status was the most important (0.212).Conclusion The situation of burnout of nurses in pediatric wards is grim, and it is recommended that managers adopt humanized management, such as caring for the physical and mental health of pediatric nurses, optimizing pediatric nursing human resources, improving performance appraisal and promotion mechanism, and improving job satisfaction, etc., to reduce burnout and stabilize the pediatric nursing team.
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  Elderly care mode and influencing factors of combined medical and elderly care demonstration cities in Shandong Province

  Gao Wenhui, Liu Ronghang, Yuan Shijia, Shao Xiaoqian, Zhao Surong, Wang Guangcheng, Han Chunlei

  journal1. 2023, 30(5): 353-358. https://doi.org/10.3969/j.issn.1006-5253.2023.05.006

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  Objective To understand the mode of elderly care and its influencing factors in demonstration cities of the combination of medical care and elderly care in Shandong Province, and to provide countermeasures and suggestions for improving the quality of elderly care.Methods A multistage stratified random sampling method was used to conduct an on-site questionnaire survey of 1 752 elderly people in Jinan and Yantai, the leading demonstration cities for the integration of medical care and elderly care in Shandong Province. The data were processed by using descriptive statistical analysis, chi-square test, logistic regression and multiple response analysis.Results Home care is the most popular mode to support the elderly (85.0%), followed by community care (9.5%), and institutional care (5.5%). The single factor results showed that age, place of residence, number of children, education level and other 8 factors were the influencing factors of elderly care mode (P<0.05). Logistic regression analysis showed that self-care ability is an influencing factor in the way of home care (P<0.05). Health status, self-care ability and education level are the influencing factors of community care (P<0.05). Age and self-care ability are the influencing factors of institutional care (P<0.05).Conclusion Home care is still the main mode for the elderly. Different modes of elderly care are affected by multiple factors. Different measures need to be taken to meet the needs of the elderly according to different modes of elderly care.
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  Statistics and analysis of performance appraisal indicators for tertiary public hospitals based on SQL

  Chen Hanjie，Chen Yun，Lu Hong， Xu Chang，Duan Jun，Wu Shichao，Diao Yuhan，Liu Yan

  journal1. 2023, 30(5): 359-365. https://doi.org/10.3969/j.issn.1006-5253.2023.05.007

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  Objective To provide a multi-dimensional, efficient, and high-quality statistical analysis method for some indicators related to the first page of medical records in the performance appraisal of tertiary public hospitals.Methods Microsoft SQL Server query analyzer was used to connect with the back-end database of the medical record statistics management system, and the data could be statistically analyzed by writing structured query language (SQL).Results By executing the prepared SQL statements, the required data could be queried quickly. The generated statistical results could be intuitive, accurate, and easy to operate. It met diversified statistical needs and effectively improved the data quality, which played an essential role for hospitals to make management decisions.Conclusion The application of SQL statements can effectively solve the difficulties during statistical work in hospitals, and improve the work efficiency and work quality compared with traditional statistical methods. Hospital statisticians in the new era should improve their working skills, innovate their working methods, and provide better services for hospital management.
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  Influence factors analysis for execution ability of the middle-level managers in public hospitals based on mixed research method

  Zhang Jie，Cai Yijun，Tang Wenjie，Zhang Tiansong

  journal1. 2023, 30(5): 366-370. https://doi.org/10.3969/j.issn.1006-5253.2023.05.008

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  Objective To explore the current situation and influence factors for execution ability of the middle-level managers in public hospitals based on mixed research method.Methods The current situation of middle-level cadres′ ability to grasp and implement in public hospitals was understood through interviews and questionnaires, and the factors influencing the ability of middle-level cadres to grasp and implement were comprehensively analyzed by factor analysis and Bayesian ordered logistic regression.Results Twenty-six
  interviewees and 215 respondents were included this study. It was considered that political ability was the most important in 11 (42.31%) of 26 interviewees, and execution ability was the most important in 8 (30.77%) of 26 interviewees. The factor analysis showed that the three dimensions of the execution ability were basic ability, synthetic ability, development ability. The total scores were over 4.5 in avoiding the implementation, delaying the implementation, passivating the implementation, and being bad at implementation. The Bayesian  ordered  logistic regression analysis showed that the two advantage influence factors on the execution ability were the individual comprehensive quality (OR=1.46, 95%CI: 1.01-2.08) and hospital incentive assessment (OR=2.36, 95%CI: 1.30-4.14).Conclusion There were some problems such as avoiding the implementation, delaying the implementation, passivating the implementation, and being bad at implementation in middle-level managers of public hospitals. The individual comprehensive quality and hospital incentive assessment may improve the execution ability.
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  Research on grouping hospitalization expenses of cataract patients based on decision tree model 

  Weng Xiaoyu，Xi Shuxin，Fang Chao

  journal1. 2023, 30(5): 371-375. https://doi.org/10.3969/j.issn.1006-5253.2023.05.009

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  Objective To study the disease diagnosis related groups and hospitalization expense standard of cataract patients, and to provide reference for medical institutions to formulate hospitalization expense groups and improve the system.Methods The data of the first page of medical records of cataract patients from January 1 to December 31, 2021 were selected from a tertiary specialized hospital in Shanghai. The influencing factors of hospitalization expenses were analyzed by single factor analysis and multiple linear regression, and the classification node variables were screened out. The decision tree model was used to construct the grouping scheme and cost standard of cataract hospitalization costs.Results Totally 6 321 cataract inpatients were included in this study. The results of single factor analysis showed that the hospitalization expenses of patients with different age, hospitalization days, hospitalization times, surgical condition, and treatment or main surgical methods were statistically significant (P<0.05). The results of multiple linear regression analysis showed that age, hospitalization days, hospitalization times, and treatment or main surgical methods were the main factors affecting hospitalization expenses (F=385.47，P＜0.01，R2=0.328). The decision tree model formed a total of 6 groups and corresponding cost standards (risk value of the model was 0.03, CV of each group was 0.03-0.13, RIV=0.32).Conclusion It is reasonable to group the hospitalization expenses of cataract cases through the decision tree model. It is recommended that medical institutions refine the cost control of cataract diseases based on case grouping, further reasonably control medical operating costs, and adjust and optimize disease diagnosis related grouping by the medical insurance management department.
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  Structural equation model validation study on the influencing factors of high hospitalization expenses in dermatology hospitals

  Lin Jinxiong，Liu Jinlong，Shen Shuqun

  journal1. 2023, 30(5): 376-380. https://doi.org/10.3969/j.issn.1006-5253.2023.05.010

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  Objective To analyze the influencing factors of high hospitalization expenses in a certain tertiary dermatology hospital, and to provide references for reducing the medical burden of patients and optimizing the structure of medical cost.Methods The hospitalization data of patients with high hospitalization costs from 2015 to 2019 in a large tertiary dermatology hospital in Guangdong Province were taken as an example, and variance statistics and structural equation modeling were used to analyze the influencing factors of high hospitalization costs.Results Age (β=-0.072, P<0.001), surgery (β=0.157, P=0.001), hospital infection (β=0.043, P=0.030), readmission within the month (β=0.040, P=0.011), use of antibiotics (β=0.155, P<0.001), and the length of hospital stay (β=0.304, P<0.001) directly affected hospitalization costs, while age (β=0.028, P<0.001), marital status (β=0.021) , P＜0.001), comorbidity (β=0.026, P＜0.001), hospital infection (β=0.017, P＜0.001), use of antibiotics (β=0.089, P＜0.001), and clinical pathway (β=0.001, P=0.001) indirectly affected the hospitalization cost by acting on the length of stay, and the length of stay had the greatest impact on the high hospitalization cost of patients with skin diseases (β=0.304, P＜0.001).Conclusion Shortening the length of hospital stay, improving the level of surgery, rationally using antibiotics, controlling hospital infections, reducing comorbidities and readmission within the month, and improving clinical pathway management are one of the effective strategies to control the high hospitalization costs in dermatology hospitals. At the same time, the monitoring of elderly and married patients should be strengthened.
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  Decision tree analysis of hospitalization expenses for ischemic heart disease patients with multiple chronic diseases 

  Mao Ying，Sun Lili，Liu Fang，Yang Shumei，Guo Lingli，Wang Lei

  journal1. 2023, 30(5): 381-386. https://doi.org/10.3969/j.issn.1006-5253.2023.05.011

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  Objective To analyze the influencing factors of hospitalization expenses for ischemic heart disease patients with multiple chronic diseases in Xinjiang, and to predict the hospitalization expenses in patients with ischemic heart disease and the key differences.Methods The E-CHAID method was used to analyze the influencing factor data of hospitalization expenses for patients with multiple chronic ischemic heart diseases in Xinjiang, and the data were performed optimal segmentation to establish a case combination model. The structure and scale of the decision tree were controlled by pruning to predict the influencing factors, optimal combination path, and hospitalization expenses of ischemic heart patients with multiple chronic diseases.Results The 5 factors were treatment method, actual length of hospital stay, number of complications, the type of diseases, and chronic kidney disease or not. Through the decision tree model, 14 optimal combination paths are formed. Conclusion The decision tree model can be used to analyze the key factors affecting hospitalization expenses, but also help the health management departments to find the optimal grouping path, so as to provide ideas and assistance for optimizing clinical pathways and reforming medical insurance payments in the future.
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  Influencing factors of hospitalization expenses of type 2 diabetes patients based on classification tree model

  Li Wen，Zhang Man

  journal1. 2023, 30(5): 387-390. https://doi.org/10.3969/j.issn.1006-5253.2023.05.012

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  Objective To analyze the influencing factors of hospitalization expenses of type 2 diabetes patients in a tertiary hospital in Foshan City with a classification tree model, to provide a basis for the hospital to control medical expenses, to optimize the allocation of resources, and to improve the system design.Methods The medical records of type 2 diabetes patients discharged from the hospital from January to December 2021 were taken as the research objects. A chisquare test was used for single factor analysis, and a classification tree model was used for multiple factors analysis.Results The median of hospitalization cost of type 2 diabetes patients in the hospital was 6 370.64 yuan, with the highest diagnosis cost and the second drug cost. The hospitalization cost was related to the length of stay, the number of complications, the payment method and the admission route.Conclusion The structure of hospitalization cost is unreasonable and needs further optimization. It should be reduced by shortening hospitalization time, improving the level of medical treatment, strengthening publicity and education and formulating relevant policies.

   
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  Study on the change trend and flow of emergency department visits of a tertiary hospital in Xinjiang from 2018 to 2021

  Ren Jiale，Guo Xuan，Xu Shanshan，Zhang Wei，Yang Jianzhong

  journal1. 2023, 30(5): 391-395. https://doi.org/10.3969/j.issn.1006-5253.2023.05.013

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  Objective To analyze the change trend on the flow of emergency department visits in a tertiary hospital in Xinjiang in the past four years, and to provide data support for strengthening the hospital management, optimizing treatment process and improving emergency department service quality.Methods We retrospectively analyzed 243 218 patients with complete data of 4 years of visits in the emergency department, from January 1, 2018 to December 31, 2021, the seasonal index of emergency department visits was calculated by time series seasonal index analysis method, and the change flow of the number of emergency department patients in time was analyzed. Results There are some periodic variations in the number of emergency department visits. In the past four years, 243 218 patients have been admitted to the emergency department, and the number of emergency patients was on the rise, with more males (52.0%) than females (48.0%). The peak months of emergency visits were April, May, June, July, September and October, with the largest number of patients in May. The minimum number of the emergency visits occurred in January, February and March, and the number of patients was the least in February. The third quarter was the peak, and the first quarter was the trough. Monday, Tuesday, Saturday and Sunday were the peak time for medical treatment, and the highest peak was Sunday. Wednesday, Thursday, and Friday were the lower period, and Friday was the lowest period. The daytime peak was from 12∶〖KG-*2/3〗00 to 14∶〖KG-*2/3〗00, and the night peak was from 22∶〖KG-*2/3〗00 to 24∶〖KG-*2/3〗00.Conclusion There are certain seasonal changes in the number of patients in the emergency department of the hospital, which has a certain reference role in scientifically allocating emergency department medical staff, optimizing the treatment process and improving the quality management of medical care.
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  Trend analysis of changes in outpatient visits in a psychiatric hospital from 2013 to 2022

  Ji Yan

  journal1. 2023, 30(5): 396-400. https://doi.org/10.3969/j.issn.1006-5253.2023.05.014

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  Objective To analyze the dynamic change pattern of hospital outpatient volume through statistics, and to provide reference basis for the formulation of hospital development planning and rational allocation of resources.Methods The outpatient workload of a second-class psychiatric hospital from 2013 to 2022 was collected, and seasonal index analysis and moving average trend elimination method were used to analyze statistically the monthly, quarterly, and annual outpatient volume.Results The number of outpatient visits showed an increasing trend year by year, with 35 815 outpatient visits in 2022, which was 126.23% higher than 15 831 visits in 2013; the monthly seasonal index was the highest in December at 116.77%, and the lowest in February at 74.42%; and the quarterly seasonal index was the highest in the fourth quarter at 105.36%, and the lowest in the first quarter at 95.4%.Conclusion The hospital outpatient volume is rising year by year, with obvious periodicity and regularity, which provides a scientific basis for hospital management and decision-making.