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2024 Vol. 31, No. 3
Published: 2024-06-25
161
DRG-based evaluation of neonatal inpatient medical services in municipal hospitals
Fu Jian
DOI: 10.3969/j.issn.1006-5253.2024.03.001
Guide::
Objective
To evaluate the performance of n neonatal inpatient medical services in municipal hospitals based on DRG-indicators.
Methods
Medical records of neonatal inpatients reported by all municipal medical institutions were collected, and the top 10 hospitals were included in the analysis. The medical service was evaluated from the three dimensions of service ability, service efficiency, and medical quality and safety, and the comprehensive index method was used to compare the medical service with the list of provincial key clinical specialties.
Results
The kinds of DRG groups were comprehensive, with no death cases in the low-risk group. Hospital A ranked first in terms of capacity index and comprehensive ranking, while hospitals D and H ranked first in efficiency index, and Hospital E ranked first in terms of DRG groups and CMI.
Conclusion
The coverage of neonatal disease treatment was wide and the medical quality was pretty well in the city. However, there is a need for balanced development between medical service capacity and efficiency, and more attention should be paid to the specify dimensions of indicators, rather than a single comprehensive ranking.
2024 Vol. 31 (3): 161-164 [
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24
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165
Risk assessment of nosocomial infection in second-class general hospitals based on risk matrix
Ma Dehui，Han Shuanghai，Long Yan
DOI: 10.3969/j.issn.1006-5253.2024.03.002
Guide::
Objective
To apply the risk matrix to assess the risk of nosocomial infection management in upper second-class general hospitals.
Method
s The incidence rate, infection site, increased length of hospital stay, increased hospitalization cost, outcome, and monthly incidence variation coefficient of patients with nosocomial infection in each department in 2021 were used to quantify the probability of occurrence and consequence indicators, and the risk identification of internal medicine, surgery, and obstetrics and gynecology and children systems was carried out. Percentile method (P
20
, P
40
, P
60
, P
80
) was used to grade the occurrence possibility and consequence, establish the risk matrix table, and analyze and determine the high-risk departments.
Results
The high-risk departments in internal medicine were oncology department, geriatric disease department, general medicine department and infectious disease department; the high-risk departments in surgical medicine were neurosurgery department, otolaryngology department and orthopedics department; the high-risk departments in gynecology and pediatrics system were obstetrics and gynecology.
Conclusion
The risk assessment model of nosocomial infection based on risk matrix truly and objectively reflects the risk of nosocomial infection in various departments of primary hospitals, which suggests that primary hospitals should give priority to the prevention and control strategy of nosocomial infection in high-risk general departments, and pay attention to key departments such as neonatology.
2024 Vol. 31 (3): 165-168 [
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169
Comprehensive evaluation of medical quality and operation efficiency of 57 tertiary general hospitals in Shandong Province
Zhang Yongyuan，Li Xiangyi，Pang Fengrui，Liu Guochao，Wang Qingliang
DOI: 10.3969/j.issn.1006-5253.2024.03.003
Guide::
Objective
To take 57 tertiary general hospitals in Shandong Province as study samples, to evaluate the medical quality and operation efficiency, and to provide references for strengthening connotation construction and improving the refined management level.
Methods
Entropy weighted technique for order preference by similarity to ideal solution (TOPSIS) and data envelopment analysis (DEA) were respectively used to evaluate the medical quality and operation efficiency in sample hospitals, by constructing the evaluation index system.
Results
In terms of medical quality, there was significant difference in highlevel surgical proportion and CMI among sample hospitals, with the maximum weight of both. The top ranked hospitals were A1, A2, A3, A4 and A29, all of which were tertiary and mostly provincial hospitals. In terms of operation efficiency, the overall efficiency of 57 sample hospitals was relatively high, but imbalance development still existed, with 22 hospitals DEA effectiveness, 12 hospitals DEA weakly effectiveness, and 23 hospitals DEA ineffectiveness. There was a positive correlation between medical quality and technical efficiency.
Conclusion
There is a big space for improvement of the medical quality and operation efficiency in some sample hospitals. They should focus on functional orientation, continuously enhance medical technology level and internal management capability, optimize resources allocation, and transform from scale expansion to quality and efficiency improvement, in order to promote the high-quality development of hospitals.
2024 Vol. 31 (3): 169-174 [
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175
Statistical analysis of death cases among inpatients from a tertiary general hospital from 2018 to 2022
Shao Danting，Pu Xiaoyan，Yang Xiaofang，Zhao Sunfeng，Guo Shengcai
DOI: 10.3969/j.issn.1006-5253.2024.03.004
Guide::
Objective
To analyze the disease characteristics of inpatient deaths in a tertiary general hospital from 2018 to 2022, and provide reference for the rational allocation of medical resources and the strengthening of medical quality management.
Methods
All inpatient information from the hospital information system from January 1, 2018 to December 31, 2022 were extracted for statistical analysis from the aspects of gender，age，death disease，case fatality rate, and death disease composition of hospitalized deaths with the use of Excel 2007 and SPSS 18.
Results
The mortality rate of inpatients was 0.64%. There were 443 male cases (65.63%) and 232 female cases(34.37%) among the 675 deaths. The top three causes of death were circulatory system diseases, respiratory system diseases, and tumors accounting for 28.44%，28.30%，and 27.56% of total deaths, respectively. The gender ratio of male to female deaths was 1.91∶1, the fatality rate was higher in males than in females, and the difference was statistically significant (χ2=46.068， P<0.001). The higher the age, the higher the fatality rate. The mortality rate rapidly increased after the age of 50.
Conclusion
The mortality rate of inpatients in the hospital is generally low, and the elderly are at high risk of death. Circulatory system diseases, malignant tumors and respiratory system diseases were the main causes of death．In medical work, medical resources should be scientifically and reasonably allocated based on patient gender, age, high incidence of mortality, and department characteristics to reduce case fatality rate.
2024 Vol. 31 (3): 175-178 [
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179
Analysis of coupling coordination degree between supply and utilization of medical resources in Guangdong Province
Chen Dongyao，Zhu Limeng，Lai Songsheng，Ren Lijie
DOI: 10.3969/j.issn.1006-5253.2024.03.005
Guide::
Objective
To analyze the coupling coordination of medical resources supply and utilization in Guangdong Province in the past five years, and to provide theoretical support for optimizing resources supply and spatial distribution and promoting the coordinated development of supply and utilization in Guangdong Province.
Methods
The supply and utilization level of medical resources in 21 cities in Guangdong Province in 2018 and 2022 were analyzed by coupling coordination model and GIS spatial analysis.
Results
The comprehensive level of medical resource supply in Guangdong Province increased from 0.37 to 0.45, and the comprehensive level of utilization decreased from 0.48 to 0.39. In 2018 and 2022, the medical resources supply subsystem and utilization subsystem were in a high-level coupling state, with the mean values of 0.97 and 0.96, respectively. However, the mean values of the coupling coordination degree did not change much in the past five years, 0.64 and 0.63 respectively, and were in a moderate coordination state, showing a trend of high in the west and low in the east, and high in the north and low in the south, with spatial aggregation.
Conclusion
The coupling coordination degree between medical resource supply and utilization is not high, and the regional differences are obvious. In formulating policies to optimize the distribution of medical resources, attention should be paid to the coordinated development of the two subsystems, and corresponding strategies should be proposed according to the different coupling coordination degrees and lagging types of different cities and regional heterogeneity. At the same time, the advantages of the Guangdong-Hong Kong-Macao Greater Bay Area should be taken into account to strengthen inter-regional cooperation and realize the optimal allocation of resources in different regions.
2024 Vol. 31 (3): 179-184 [
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185
Prediction of outpatient visits in tertiary general hospitals based on seasonal ARIMA model
Chen Wenjuan，Lin Jianchao
DOI: 10.3969/j.issn.1006-5253.2024.03.006
Guide::
Objective
To predict the outpatient volume of a tertiary general hospital in Zhejiang Province by establishing the seasonal ARIMA model, and to provide a basis for the rational allocation of outpatient human resources.
Methods
Based on the outpatient visits data of a tertiary general hospital in Zhejiang Province from January 2013 to June 2023, the seasonal ARIMA model was constructed by SPSS software to predict the annual outpatient visits from July 2023 to December 2023. By comparing the measured outpatient visits, the accuracy of the seasonal ARIMA model was evaluated.
Results
The outpatient volume of the general hospital showed an increasing trend year by year, and showed the characteristics of periodic fluctuations. The optimal seasonal ARIMA model fitted was ARIMA(0,1,1)(1,0,1)12, BIC (Bayesian information criterion) was 5.273, MAPE (mean absolute percentage error) was 14.265, R2 (module determination coefficient) was 0.408, and the overall relative error was 1.83%, indicating good prediction results.
Conclusion
The seasonal ARIMA model can simulate the change trend of the outpatient volume in the time series of the tertiary general hospital well, and provide a theoretical basis for the short-term forecast of the outpatient volume in the hospital.
2024 Vol. 31 (3): 185-188 [
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25
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189
Analysis on effect of air NO
2
on hospital visits for respiratory diseases in Jiaxing
Hong Weiwei，Wu Yikang，Zhu Ze，Wang Xibei，Wu Daming，Zhou Zhehua
DOI: 10.3969/j.issn.1006-5253.2024.03.007
Guide::
Objective
To analyze the effect of nitrogen dioxide (NO
2
) on hospital visits for respiratory diseases in Jiaxing.
Methods
We collected daily air NO
2
monitoring data, meteorological factors and hospital visits for respiratory diseases in Jiaxing from 2019 to 2021．We used Wilcoxon rank sum test and generalized addition model (GAM) to analyze the acute effects of air NO
2
on hospital visits for respiratory diseases.
Results
The average daily concentration of NO
2
exceeded the standard for 9 days. The daily hospital visits for respiratory diseases and childhood respiratory diseases on days when air NO
2
exceeded the national standard were higher than those on qualified days. In the single-day lag effect analysis, the excess risk (ER) of daily hospital visits for respiratory diseases and adult respiratory diseases both reached the maximum on lag4, while the ER of daily hospital visits for childhood respiratory diseases reached the maximum on lag3 with ER(95%CI) being 2.23% (1.52%-2.94%), 1.73%(1.06%-2.41%) and 2.73%(1.73%-3.74%) with NO
2
concentration increase per 10 μg/m3, respectively. In the cumulative lag effect analysis, the ER of daily hospital visits for respiratory diseases, adult and childhood respiratory diseases all reached the maximum on lag07, with ER(95%CI) being 5.35%(4.06%6.66%), 3.47%(2.25%-4.70%) and 7.17%(5.31%-9.07%) with NO
2
concentration increase per 10 μg/m
3
, respectively. The maximum ER of hospital visits for childhood respiratory diseases was higher than that for adults.
Conclusion
The increase of NO
2
concentration in Jiaxing may lead to an increase in hospital visits for respiratory diseases with a lag effect, and the health protection of children′s respiratory system should be especially strengthened.
2024 Vol. 31 (3): 189-192 [
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193
Change trend of the number of admissions to the otolaryngology department of a tertiary hospital
Zhang Yuan，Hou Minghua
DOI: 10.3969/j.issn.1006-5253.2024.03.008
Objective
To analyze the dynamic change of the number of admissions in the otolaryngology department of a hospital, aiming to provide a reference for the refined management of the department and the scientific allocation of medical and health resources.
Methods
The dynamic indicators in the time series analysis were used to analyze the annual change of the number of hospital admissions from 2013 to 2022, and the moving average seasonal index method was used to statistically analyze the number of hospital admissions in each month and quarter.
Results
The number of admissions to the department of otolaryngology in the hospital showed an overall growth trend, with a cumulative increase of 1 721 person-times, with a cumulative increase of 48.33%. The monthly peak period of hospital admissions was in July and August, of which July was the highest, with a seasonal index of 131.66%; and the trough period was in February, June, September, November, and December, of which September was the lowest, with a seasonal index of 79.59%. The quarterly peak was in the third quarter, with a seasonal index of 108.92%; and the trough was in the fourth quarter, with a seasonal index of 93.27%.
Conclusion
The number of admissions to the department of otolaryngology in the hospital shows obvious cyclical changes with monthly and quarterly changes, and medical and health resources should be scientifically and reasonably allocated according to the law to improve the quality and efficiency of medical services.
2024 Vol. 31 (3): 193-196 [
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Correlation analysis of psychological capital and study adaptability of male nursing undergraduates
Fu Ming, Guo Shengteng, Wang Qinghua
DOI: 10.3969/j.issn.1006-5253.2024.03.009
Objective
To explore the correlation between psychological capital and study adaptability of male nursing undergraduates.
Methods
We selected 202 male students majoring in nursing in a university by convenience sampling method, and the learning adjustment scale and psychological capital scale were used for investigation and analysis.
Results
The average score of psychological capital of male nursing undergraduates was (93.72±10.72). The average score of study adaptability was (113.96±13.65). There was a significant positive correlation between the total score of psychological capital and the total score of study adaptability (r=0.631, P<0.01). Psychological capital of male nursing students has a positive predictive effect on study adaptability.
Conclusion
Male nursing undergraduate students are in the middle level of study adaptability and psychological capital, and psychological capital has a positive predictive effect on study adaptability.
2024 Vol. 31 (3): 197-202 [
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203
Prevalence of osteoporosis and its influencing factors in middle-aged and elderly people over 45 years old in Wenzhou
Jin Xiaowei, Su Zheng, Shi Mi, Wu Jiaozhen, Lin Peipei
DOI: 10.3969/j.issn.1006-5253.2024.03.010
Objective
To investigate the prevalence of osteoporosis among middle-aged and elderly people over 45 years old in Wenzhou, and analyze its influencing factors, so as to provide basis for formulating osteoporosis prevention and control measures.
Methods
A convenient sampling method was adopted to select 1 064 residents over 45 years old in Wenzhou from July to December 2023. A questionnaire survey was carried out, and the bone density of 1/3 of the distal radius of the study subjects was measured and recorded by ultrasonic bone densitometry.
Results
Among 1 064 middle-aged and elderly people over 45 years old, 239 cases had osteoporosis, with a prevalence rate of 22.46%. The results of logistic regression analysis showed that age (OR=2.498, 95%CI: 1.0585.901), BMI (OR=1.323, 95%CI: 1.037-1.688) were the risk factors for the prevalence of osteoporosis in middle-aged and older population, and that receiving sunshine hours (OR=0.488, 95%CI: 0.266-0.895), calcium supplementation (OR=0.465, 95% CI: 0.262-0.826), and consumption of milk (OR=0.500, 95% CI: 0.286-0.874) were protective factors for the prevalence of osteoporosis in middle-aged and elderly population.
Conclusion
The prevalence of osteoporosis in the middle-aged and elderly population over 45 years old is high in Wenzhou community. Weight control, daily exposure to more than 30min of sunlight, calcium supplementation, and milk drinking can help to prevent osteoporosis in the middle-aged and elderly population and improve their quality of life.
2024 Vol. 31 (3): 203-206 [
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Relationship between self-disclosure, professional happiness and willingness to stay among pre-examination and triage nurses in tertiary hospitals
Zhang Yu， Dai Manxiang，Sui Yan，Deng Chengmeng， Liu Chunlan，Chen Xingru，Zhao Xiaomin
DOI: 10.3969/j.issn.1006-5253.2024.03.011
Objective
To understand the current status of willingness to stay of in pre-examination and triage nurses in tertiary hospitals, and to explore the relationship between willingness to stay, self-disclosur and professional happiness, so as to provide reference for reducing the turnover rate of nurses in pre-examination and triage.
Methods
A total of 230 pre-examination and triage nurses from 5 tertiary hospitals in a province were selected by convenience sampling method in September 2022. General data questionnaire, nurse willingness to stay scale, distress disclosure index scale and professional happiness scale of medical workers were used for online investigation.
Results
The total score of willingness to stay of pre-examination and triage nurses was (22.56±4.38). There was a positive correlation between nurses′ willingness to stay and self-disclosure and professional happiness (r
1
=0.206, r
2
=0.679, P<0.001). Multiple linear regression analysis showed that professional affection, nurse-patient relationship and professional happiness were the main influencing factors of nurses′ willingness to stay (R
2
=0.557, P<0.001).
Conclusion
The willingness to stay of pre-examination and triage nurses was at a medium level, and there is a lot of room for improvement. Hospital managers can enhance their willingness to stay in pre-examination and triage nurses by improving their professional affection and professional happiness.
2024 Vol. 31 (3): 207-212 [
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Application of Power BI Desktop in the fine management of hospital DIP
Zhang Lingzhen，Xie Shengtang，Wang Hui，Zeng Chunhong，Zhu Like，Liu Lianbin
DOI: 10.3969/j.issn.1006-5253.2024.03.012
Objective
To use Power BI Desktop for multidimensional comparative analysis and data visualization of hospital DIP subgroup details, in order to identify the causes of DIP losses in hospitals.
Methods
The data were extracted from the DIP subgroup discharge settlement details of a tertiary oncology hospital in 2022. Methods such as data import, data type conversion, data relationship establishment, data modeling, and data visualization were used to build dynamic analysis reports for different dimensions such as the entire hospital, departments, and disease categories.
Results
Power BI Desktop can effectively enhance the level of fine management for DIP, improve work efficiency, accurately analyze the causes of losses, guide departments in making improvements, and effectively reduce the DIP insurance fund losses for the hospital.
Conclusion
Power BI Desktop is characterized by its low cost, customization, high level of visualization and automation, as well as a user-friendly interface, making it suitable for promotion in hospitals, especially those with low levels of informatization, insufficient specialized operational personnel, and limited budget for DIP fine management.
2024 Vol. 31 (3): 213-218 [
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Exploration of pre-processing methods for scientific research of data in hospital anesthesia information management system
Xiang Rumei，Wei Xing， Dai Wei，Zhang Lijun，Xu Wei，Tian Jie，Zhang Hongwei， Sun Jiaxin，Shi Qiuling
DOI: 10.3969/j.issn.1006-5253.2024.03.013
Objective
Accurate and standardised data form the foundation for reliable research findings. Taking lung surgery as a case study, we analyse the data traits of an anesthesia information system and undertake preprocessing such as encompassing cleaning, conversion, integration and imputation to build a researchready dataset.
Methods
Relevant data from the anesthesia information system of patients undergoing lung surgery at Sichuan Cancer Hospital between April 2021 and November 2022 were collected. The characteristics of the source data were analysed, and the Python and SAS software were proposed for data preprocessing. Text data were transformed into numerical values for the ease of data mining using Python's SPLIT statements, SAS macros, and functions. Missing values were filled, and anomalies, inconsistencies, and redundant data were corrected through data cleaning and data reduction. Data integration was achieved through NOUNIQUEKEY, SQL and LAG statements to expand the data volume.
Results
Two Excel sheets were extracted from the anaesthesia information system and the hospital information system, comprising a total of 1 835 anesthesia records and 46 612 medical records. Analysis of the source data revealed that the anaesthesia information system had idiosyncratic medical lexicon, varied semantic expressions, multiple outlines for identical drugs, and certain drugs ending in "alternate". Based on the given data characteristics and semi-structured data structure, we compiled three macros to clean and validate all drug names, standardise medical terminology, and unify outlines. This process led to the extraction of 12 drugs for pre-anaesthesia, 24 drugs for intraoperative use, and 12 drugs for analgesic pumps. Secondary completion of missing data was performed, as well as noise reduction and cleaning of inconsistent data. Forty-eight anesthesia records (2.62%) of non-pulmonary were excluded and 10 irrelevant fields for the mining task were removed. After data integration, 1 748 cases of anesthesia data (97.82%) were matched with medical prescription data. After the data preprocessing described above, the final structured dataset consisted of 1 748 patients and 99 variables.
Conclusion
The anaesthesia data preprocessing process developed through the analysis of source data achieves data cleaning, data integration, data transformation and data reduction, and thus obtains standardised and precise drugs data. It provides a methodological reference for data cleaning and structuring of anaesthesia information in other institutions and at the same time provides a reliable data base for research that needs to use high quality anaesthesia medication data, which will contribute to the depth and advancement of related research.
2024 Vol. 31 (3): 219-229 [
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Interpretation of colon cancer and rectal cancer statistics in the United States in 2023 and current status of preventive management in China
Su Guoqiang, Zhou Xin, Lü You
DOI: 10.3969/j.issn.1006-5253.2024.03.014
Colorectal Cancer (CRC) statistics are updated by American Cancer Society every 3 years based on morbidity provided by the population cancer registry and mortality provided by the National Center for Health Statistics. In 2023, about 153 020 people will be diagnosed with CRC and 52 550 will die from the disease, including 19 550 cases and 3 750 deaths among people under 50 years old. The magnitude of the decline in CRC incidence has changed, from 3%4% per year in 20002010 to 1% per year in 20112019. The proportion of rectal cancer increased from 27% in 1995 to 31% in 2019, and CRC incidence was migrating to the left colon. From 2011 to 2020, CRC mortality overall decreased by 2% per year, but CRC mortality increased by 0.5%3.0% per year in the native Americans under 50 years old and under 65 years old. In summary, despite the continual decline in overall mortality, CRC is rapidly shifting towards younger, more advanced stages and development in the left colon/rectum. In this paper, the important contents of the updated data are sorted out and briefly interpreted. At the same time, compared with the present situation of CRC in our country, we can reveal and analyze the cause of the rising incidence of CRC to provide reference for CRC diagnosis and treatment.
2024 Vol. 31 (3): 230-235 [
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Hotspots and trends of DIP research in China with social network method
Wang Jianhua， Li Yunfeng， Hu Wei，Feng Lifen
DOI: 10.3969/j.issn.1006-5253.2024.03.015
Objective
To analyze the hotspots and trends of Diagnosis-Intervention Packet (DIP) research in China in order to provide reference for the research direction.
Methods
The CNKI was used to retrieve the DIP-related literature, and descriptive analysis was conducted on the basic information such as the publication time of the literature. The social network method was used to analyze the core authors and high-frequency keywords, and visualize the connection between network nodes.
Results
From 2011 to 2023, a total of 545 related DIP literatures were published. There were 178 core journal literatures (32.66%) and 367 non-core journal literatures (67.34%). Since 2016, the DIP literature has rapidly increased, with over 200 articles published in 2023. There were 71 core authors in this field, forming 5 multi-person cooperation groups, led by Gao Guangying and Tian Jiashuai, with a total of 278 articles published. The network cograph and centrality analysis of high-frequency keywords showed that "medical insurance payment", "public hospitals", "fine management", "payment methods", and "cost control" ranked at the top of the degree centrality and proximity centrality rankings; while the intermediary centrality of "fine management" and "medical insurance payment" was relatively large.
Conclusion
The literature in DIP field is showing a continuous growth trend in China, with multiple research teams formed by core authors who have a greater influence and academic leadership role. The hotspots mainly focus on medical insurance payment and fine management in public hospitals. The development trend will go deep into many fine links such as cost control of public hospitals.
2024 Vol. 31 (3): 236-240 [
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