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Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model

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World Journal of Clinical Cases 2020年第12期8卷 2484-2493页

作者： Suo-Wei Wu Qi Pan Tong Chen Department of Medical Administration Beijing HospitalBeijing 100730China

BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while p

关键词： Diagnosis-related groups Health care cost Colorectal cancer Length of stay

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Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center

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Chinese Medical Journal 2016年第19期129卷 2325-2330页

作者： Suo-Wei Wu Qi Pan Chao Li Qin Wang Jing-Chen Song Tong Chen Department of Medical Administration Beijing Hospital Beijing 100730 China

Background：The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles,thus identifying the major influence factors for high medical expenditure to develop further research.Methods：We retrospectively studied 204l inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015.We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure.All the data and materials were collected from medical record system,and the statistical methods included t-test,variance of analysis,and multivariate linear regression.Results：The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs,which respectively accounted for 33.03% and 32.32% of the total cost;and the average length of hospital stay was 28.39 days/person.Diseases of skeletal and muscular system,circulatory system,and tumor were the top three disease categories of high inpatient expenditure,which accounted for 39.00%,33.46%,and 18.03%,respectively.Complications,criticality of the disease,gender of the patients,the occurrence of death,and the excessive length of hospital stay all had great impacts on average medical expenditure,while age,hospital infection,and surgery showed no significant impact on average medical cost.Conclusions：The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials,lacking cost control measures within the hospital,the excessive length of hospital stay for inpatients,and the unnecessary treatment for the patients.

关键词： High Inpatient Expenditure Influence Factors Medical Cost

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Development and evolution of medical technology management in China

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Chinese Medical Journal 2019年第14期132卷 1739-1741页

作者： Suo-Wei Wu Qi Pan Tong Chen Yuan-Yuan Ge Ji Luo Qin Wang Department of Medical Administration Beijing HospitalNational Center of GerontologyBeijing 100730China

The National Health Commission of the People's Republic of China (NHC) made a revision on the original version of the Regulation on the Clinical Application of Medical Technology in November 2018.[1] According to the new policy,medical institutions are endowed with the primary responsibility for the management of medical technology.This study aimed to investigate into the development and evolution of policy reform to explore the changes in the concepts and ideas of medical technology management in Chinese medical institutions.

关键词： medical technology management National Health Commission Clinical Application

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Management of Medical Technology under the New Medical Policy Background in China

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Chinese Medical Journal 2016年第22期129卷 2745-2748页

作者： Suo-Wei Wu Tong Chen Ming wu Qi Pan Yong Xuan Liang-Yu wei Qin Wang Chao Li Jing-Chen Song Department of Medical Administration Beijing Hospital Beijing 100730 China Department of Party Committee Beijing Hospital Beijing 100730 China

INTRODUCTIONThe National Health and Family Planning Commission of People＇s Republic of China released the ＂Regulations on canceling the admission approval of the third class medical technologies and relevant works＂ in July 2015. According to the new regulation, the obligations and responsibilities of health administration departments for the admission approval of the clinical applications on the third- and the second-class medical technologies will be transferred to medical institutions that perform the operations.

关键词： Admission Approval Medical Technology Medical Technology Assessment New Policy Background ProceduralSupervision

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Establishment of a Quantitative Medical Technology Evaluation System and Indicators within Medical Institutions

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Chinese Medical Journal 2018年第11期131卷 1327-1332页

作者： Suo-Wei Wu Tong Chen Qi Pan Liang-Yu wei Qin Wang Chao Li Jing-Chen Song Ji Luo Department of Medical Administration Beijing Hospital National Center of Gerontology Beijing 100730 China

Background： The development and application of medical technologies reflect the medical quality and clinical capacity of a hospital. It is also an effective approach in upgrading medical service and core competitiveness among medical institutions. This study aimed to build a quantitative medical technology evaluation system through questionnaire survey within medical institutions to perforna an assessment to medical technologies more objectively and accurately, and promote the management of medical quality technologies and ensure the medical safety of various operations among the hospitals. Methods： A two-leveled quantitative medical technology evaluation system was built through a two-round questionnaire survey of chosen experts. The Delphi method was applied in identifying the structure of evaluation system and indicators. The judgment of the experts on the indicators was adopted in building the matrix so that the weight coefficient and maximum eigenvalue （λ. max）, consistency index （CI）, and random consistency ratio （CR） could be obtained and collected. The results were verified through consistency tests, and the index weight coefficient of each indicator was conducted and calculated through analytical hierarchy process. Results： Twenty-six experts of different medical fields were involved in the questionnaire survey, 25 of whom successfully responded to the two-round research. Altogether, 4 primary indicators （safety, effectiveness, innovativeness, and benefits）, as well as 13 secondary indicators, were included in the evaluation system. The matrix is built to conduct the λ max, CI, and CR of each expert in the survey, and the index weight coefficients of primary indicators were 0.33, 0.28, 0.27, and 0.12, respectively, and the index weight coefficients of secondary indicators were conducted and calculated accordingly. Conclusions： As the two-round questionnaire survey of experts and statistical analysis were performed and credibility of the results was verified through consistency evaluation test, the study

关键词： Evaluation System Medical Management Medical Technology

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Cost Analysis of Cervical Cancer Patients with Different Medical Payment Modes Based on Gamma Model within a Grade A Tertiary Hospital

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Chinese Medical Journal 2018年第4期131卷 389-394页

作者： Suo-Wei Wu Tong Chen Qi Pan Liang-Yu wei Qin Wang Jing-Chen Song Chao Li Ji Luo Department of Medical Administration Beijing Hospital National Center of Gerontology Beijing 100730 China

Background： Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verily the application of Gamma model in medical cost analysis. Methods： The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study. Results： A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases~ 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory exainination costs showed statistical significance. The total hospitalization costs, drug costs, tre

关键词： Cervical Cancer Cost Analysis Medical Insurance Medical Management

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Establishment of a Comprehensive Evaluation System on Medical Quality Based on Cross-examination of Departments within a Hospital

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Chinese Medical Journal 2017年第23期130卷 2872-2877页

作者： Suo-Wei Wu Tong Chen Qi Pan Liang-Yu wei Yong Xuan Chao Li Qin Wang Jing-Chen Song Medical Administration Department Beijing HospitalNational Center of Gerontology Beijing 100730 China

INTRODUCTIONThe management of medical quality is the core element of hospital management, and it is reflected in every part and aspect of medical behavior. Strengthening the management on medical quality is crucial in ensuring medical safety, promoting the ability of clinical diagnoses and treatments as well as the increasing the efficiency of medical service, Oil this basis, the establishment and operation of a comprehensive evaluation system on medical quality is not only the foundation in ensuring the orderly operation of the medical behavior and medical safety but also an effective means in continuously improving the quality of medical management.

关键词： Medical Management： Medical Quality： Medical Safetv

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Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center

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Chinese Medical Journal 2017年第13期130卷 1529-1533页

作者： Suo-Wei Wu Qi Pan Tong Chen Liang-Yu wei Yong Xuan Qin Wang Chao Li Jing-Chen Song Department of Medical Administration Beijing Hospital National Center of Gerontology Beijing 100730 China

Background： With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups （DRGs） among patients with nnstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Methods： Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital （China） whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure,and decision tree method was adopted to establish the model of DRGs grouping combinations. Results： The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications （CCs） of the disease, and the 3933 cases were divided into ten DRGs by four factors： age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant （P 〈 0.001, by Kruskal-Wallis test）, with R2 = 0.53 and coefficient of variation （CV） 0.524. Conclusions： The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

关键词： Angina, Unstable Decision Trees Diagnosis-related Groups Health Care Costs

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Down-regulation of Risa improves podocyte injury by enhancing autophagy in diabetic nephropathy

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Military Medical Research 2023年第1期10卷 32-44页

作者： Pei-Pei Su Dong-wei Liu Si-Jie Zhou Hang Chen Xian-Ming wu Zhang-suo Liu Department of Nephrology the First Affiliated Hospital of Zhengzhou UniversityResearch Institutes of NephropathyZhengzhou UniversityZhengzhou 450052China Department of Nephrology and Rheumatology the Third People’s Hospital of ZhengzhouZhengzhou 450002China Henan Province Research Center for Kidney Disease Zhengzhou 450052China Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province Zhengzhou 450002China

Background: LncRNA AK044604(regulator of insulin sensitivity and autophagy, Risa) and autophagy-related factors Sirt1 and GSK3β play important roles in diabetic nephropathy(DN). In this study, we sought to explore the effect of Risa on Sirt1/GSK3β-induced podocyte injury.Methods: Diabetic db/db mice received Risa-inhibition adeno-associated virus(AAV) via tail vein injection, and intraperitoneal injection of lithium chloride(LiCl). Blood, urine, and kidney tissue samples were collected and analyzed at different time points. Immortalized mouse podocyte cells(MPCs) were cultured and treated with Risa-inhibition lentivirus(LV), EX-527, and LiCl. MPCs were collected under different stimulations as noted. The effects of Risa on podocyte autophagy were examined by qRT-PCR, Western blotting analysis, transmission electron microscopy,Periodic Acid-Schiff staining, and immunofluorescence staining.Results: Risa and activated GSK3β were overexpressed, but Sirt1 was downregulated in DN mice and high glucosetreated MPCs(P<0.001, db/m vs. db/db, NG or HM vs. HG), which was correlated with poor prognosis. Risa overexpression attenuated Sirt1-mediated downstream autophagy levels and aggravated podocyte injury by inhibiting the expression of Sirt1(P<0.001, db/m vs. db/db, NG or HM vs. HG). In contrast, Risa suppression enhanced Sirt1-induced autophagy and attenuated podocyte injury, which could be abrogated by EX-527(P<0.001, db/db+Risa-AAV vs. db/db, HG+Risa-LV vs. HG). Furthermore, LiCl treatment could restore GSK3β-mediated autophagy of podocytes(P<0.001, db/db+LiCl vs. db/db, HG+LiCl vs. HG), suggesting that Risa overexpression aggravated podocyte injury by decreasing autophagy.Conclusions: Risa could inhibit autophagy by regulating the Sirt1/GSK3β axis, thereby aggravating podocyte injury in DN. Risa may serve as a therapeutic target for the treatment of DN.

关键词： Diabetic nephropathy LncRNA AK044604/Sirt1/GSK3β Autophagy

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硫氧还蛋白还原酶抑制剂乙烷硒啉逆转顺铂耐药及其机制研究（英文）

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2017年第5期18卷 373-382页

作者： suo-fu YE Yong YANG Lin wu wei-wei MA Hui-hui ZENG State Key Laboratory of Natural and Biomimetic Drugs Peking UniversityBeijing 100191China School of Pharmaceutical Sciences Peking UniversityBeijing 100191China Keaise Clinical Examination Lab Wuhan 430000China

目的:研究凋亡调控相关蛋白来了解顺铂耐药成因,同时考察乙烷硒啉(Ethaselen)在K562耐药细胞中逆转顺铂耐药的作用,并初步探讨其作用机制。创新点:首次研究乙烷硒啉在逆转顺铂耐药中的作用,且此作用与乙烷硒啉诱导细胞凋亡相关。方法:... 详细信息

目的:研究凋亡调控相关蛋白来了解顺铂耐药成因,同时考察乙烷硒啉(Ethaselen)在K562耐药细胞中逆转顺铂耐药的作用,并初步探讨其作用机制。创新点:首次研究乙烷硒啉在逆转顺铂耐药中的作用,且此作用与乙烷硒啉诱导细胞凋亡相关。方法:通过长时间脉冲诱导得到顺铂耐药K562细胞,并观察耐药细胞形态及倍增时间。采用MTT法考察乙烷硒啉、顺铂及其联用组在不同细胞株间的生长抑制作用。流式细胞术分析细胞凋亡情况以及细胞内活性氧(ROS)水平。最后,通过蛋白质免疫印迹(Western blot)考察凋亡调控相关蛋白水平的变化。结论:脉冲诱导得到的K562耐药细胞对顺铂的耐受性是原K562细胞的5.34倍。形态学观察发现,耐药细胞体积增大,粘附性进一步降低。乙烷硒啉与顺铂联用表现出协同效应。当加入少量的乙烷硒啉(顺铂与乙烷硒啉的摩尔比率为10:1),顺铂作用K562耐药细胞的半抑制浓度(IC50)值可以减少21倍。流式细胞术及Western blot表明,乙烷硒啉能够诱导耐药细胞凋亡。其逆转顺铂耐药主要是通过调控Bcl-2及Bax蛋白比例以及通过提高细胞内活性氧水平引起线粒体通透转运孔道(PTP)蛋白孔道的形成来促使释放细胞色素c,进而引起Caspase凋亡途径。

关键词：乙烷硒啉顺铂耐药 K562 凋亡 Bcl-2

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