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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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Effect of salvianolic acid A and C compatibility on inflammatory cytokines in rats with unilateral ureteral obstruction

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Journal of Traditional Chinese Medicine 2015年第5期35卷 564-570页

作者： Li Jun Gu Tong Fu Xu Zhao Renjie department of administration Zunyi Medical College department of Nephrology the Fifth Affiliated Hospital of Zunyi Medical College

OBJECTIVE:To investigate the effect of salvianolic acid A and C component molecules,which are involved in drug compatibility,on inflammatory cytokine expression that affects human chemokine ligand 5(CCL5) and chemokine ligand 10(CXCL10)levels in rats with unilateral ureteral obstruction(UUO).METHODS:Fifty Sprague Dawley rats were randomly divided into five groups:normal,model,salvianolic acid A,salvianolic acid C and salvianolic acid A and C groups.The normal group was used as the control,and the other groups of rats had a UUO model established.The control group had free access to food and water,and the other groups received the corresponding drugs for 2 weeks.After the last administration,urine β_2-microglobulin(β_2-MG) and N-acetyl-β-D-glucosaminidase(NAG) levels were analyzed.After 24 h,all rats were sacrificed and the serum was analyzed for creatinine(Cr) and blood urea nitrogen(BUN) levels.Rat kidneys were removed,and CCL5 and CXCL10 inflammatory cytokine mRNA expression was measured using real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR).Kidney fibrosis was observed using hematoxylin-eosin(HE)staining and Masson trichrome staining.RESULTS:In the salvianolic acid A and salvianolic acid C treatment groups,serum Cr and urine NAG levels were significantly lower than in the model group(both P < 0.05).In all treatment groups,urine pYMG levels were significantly lower than in the model group(all P < 0.05).Compared with model group,the pathological changes and collagen deposition improved to varying degrees(both P <0.05).CCL5 and CXCL10 mRNA expression decreased to different degrees compared with the model group(both P < 0.05).CONCLUSION:Salvianolic acid A and C are component molecules of drug compatibility,and they may protect renal function and improve tubular function and renal pathology to a certain degree in UUO.This improvement may be related to a reduction in inflammatory cytokines CCL5 and CXCL10 secretion in the UUO rat kidney.

关键词：炎性细胞因子 SD大鼠输尿管酚酸梗阻单侧兼容性反转录聚合酶链反应

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Induced pluripotent stem cell-derived neural stem cell therapies for spinal cord injury

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Neural Regeneration Research 2015年第1期10卷 10-16页

作者： Corinne A.Lee-Kubli Paul Lu department of Neurosciences University of California Veterans administration medical Center

The greatest challenge to successful treatment of spinal cord injury is the limited regenerative capacity of the central nervous system and its inability to replace lost neurons and severed axons following injury. Neural stem cell grafts derived from fetal central nervous system tissue or embryonic stem cells have shown therapeutic promise by differentiation into neurons and glia that have the potential to form functional neuronal relays across injured spinal cord segments. However, implementation of fetal-derived or embryonic stem cell-derived neural stem cell ther- apies for patients with spinal cord injury raises ethical concerns. Induced pluripotent stem cells can be generated from adult somatic cells and differentiated into neural stem cells suitable for therapeutic use, thereby providing an ethical source of implantable cells that can be made in an autologous fashion to avoid problems of immune rejection. This review discusses the therapeutic potential of human induced pluripotent stem cell-derived neural stem cell transplantation for treatment of spinal cord injury, as well as addressing potential mechanisms, future perspectives and challenges.

关键词： transplantation axonal growth axonal regeneration neuroprotection remyelination differentiation neuronal relay human astrocytes neurons oligodendrocytes secondary degeneration

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Using Plan-Do-Check-Act Circulation to Improve the Management of Panic Value in the Hospital

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Chinese medical Journal 2015年第18期128卷 2535-2538页

作者： Suo-Wei Wu Tong Chen Yong Xuan XJ-Wu Xu Qi Pan Liang-Yu Wei Chao Li Oin Wang Department of Medical Administration Beijing Hospital Beijing 100730 China

The concept ＂panic value＂（or critical value） was first brought tip by American scholar Lundberg in 1972. It refers to the results of auxiliary examinations that are widely deviating from normal or anticipated results. The occurrence of these abnomaal results shows that patients could be in a dangerous situation that their lives might be threatened. If clinicians are able to get the information in time and provide the patients with effective interventions or treatments promptly, lives could be saved. Otherwise, there could be serious consequences and the best opportunities for rescuing the patients might be missing The management of panic value is an important component of medical quality management, as the National Health and Family Planning Commission has clearly defined in the ＂patient safety goals＂ for several consecutive years. In countries such as America, Australia as well as Gennany, the management of panic value has also been greatly emphasized and was been included in various hospital assessments.

关键词： Continuous Improvement Panic Value： Plan-Do-Check-Act Circulation

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Regulation of enolase activation to promote neural protection and regeneration in spinal cord injury

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Neural Regeneration Research 2023年第7期18卷 1457-1462页

作者： Hannah MMcCoy Rachel Polcyn Naren LBanik Azizul Haque department of Microbiology and Immunology Medical University of South CarolinaCharlestonSCUSA department of Neurosurgery Medical University of South CarolinaCharlestonSCUSA Ralph H.Johnson Veterans administration medical Center CharlestonSCUSA

Spinal cord injury(SCI)is a debilitating condition characterized by damage to the spinal cord resulting in loss of function,mobility,and sensation with no U.S.Food and Drug administration-approved cure.Enolase,a multifunctional glycolytic enzyme upregulated after SCI,promotes pro-and anti-inflammatory events and regulates functional recovery in SCI.Enolase is normally expressed in the cytosol,but the expression is upregulated at the cell surface following cellular injury,promoting glial cell activation and signal transduction pathway activation.SCI-induced microglia activation triggers pro-inflammatory mediators at the injury site,activating other immune cells and metabolic events,i.e.,Rho-associated kinase,contributing to the neuroinflammation found in SCI.Enolase surface expression also activates cathepsin X,resulting in cleavage of the C-terminal end of neuron-specific enolase(NSE)and non-neuronal enolase(NNE).Fully functional enolase is necessary as NSE/NNE C-terminal proteins activate many neurotrophic processes,i.e.,the plasminogen activation system,phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B,and mitogen-activated protein kinase/extracellular signal-regulated kinase.Studies here suggest an enolase inhibitor,ENOblock,attenuates the activation of Rho-associated kinase,which may decrease glial cell activation and promote functional recovery following SCI.Also,ENOblock inhibits cathepsin X,which may help prevent the cleavage of the neurotrophic C-terminal protein allowing full plasminogen activation and phosphatidylinositol-4,5-bisphosphate 3-kinase/mitogen-activated protein kinase activity.The combined NSE/cathepsin X inhibition may serve as a potential therapeutic strategy for preventing neuroinflammation/degeneration and promoting neural cell regeneration and recovery following SCI.The role of cell membrane-expressed enolase and associated metabolic events should be investigated to determine if the same strategies can be applied to other neurodegenerative diseases.Hence,this review discus

关键词： cathepsin X ENOblock enolase glia mitogen-activated protein kinase/extracellular signal-regulated kinase neurodegeneration neuroinflammation phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B Rho-associated protein kinase spinal cord injury

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Responding to fire in an intensive care unit: Management and lessons learned

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World Journal of Emergency Medicine 2018年第2期9卷 154-156页

作者： Navneet Dhaliwal Ranjitpal Singh Bhogal Ashok Kumar Anil Kumar Gupta department of Hospital administration Postgraduate Institute of MedicalEducation and Research

Healthcare institutions are vulnerable to disruptionfrom events such as earthquakes, fires, and floods, andthe damage incurred can endanger the lives of patientsin the hospital.[1] In this type of scenario hospital staffhave primary responsibility for the hospitalized patients＇safety, since patients are neither fit to respond to sucha disaster, nor do they know how to respond.[2,3] Thesituation becomes more difficult and challenging if thedisaster occurs in critical care areas such as intensivecare units （ICUs） and operating rooms.

关键词： ICU Management and lessons learned Responding to fire in an intensive care unit

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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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Botanical drug clinical trial: Common issues and future options

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Acta Pharmaceutica Sinica B 2021年第1期11卷 300-303页

作者： Yu Sun Jiahua Qian department of Traditional Chinese Medicine and Ethnopharmaceuticals Center for Drug EvaluationNational Medical Products AdministrationBeijing 100022China Center for Drug Evaluation National Medical Products AdministrationBeijing 100022China

In order to understand this disparity between human use and drugs approved by regulatory agencies,we analyzed botanical drug clinical trials registered at ClinicalTrial.gov to detect trends in current trials and guide future trials.A total of 195 botanical drug clinical trials were registered from 2016 to2019,of which 81 are phaseⅡor phaseⅡ/Ⅲ.95%of all phaseⅡandⅡ/Ⅲstudies were designed with100 or less participants per arm,indicating a more observational nature due to the limited power to detect differences in outcomes between treatment and control groups.Due to the limited number of participants,efficacy outcome from results may be highly subjective.14%of the total trials were phaseⅠstudies.For botanical drugs with well-documented or extensive history of human use,phaseⅠmay not provide significant additional information,and may,therefore,not be necessary.For the trial design,we suggest added-on studies when botanical drugs are used as part of a combination treatment.Additionally,we believe standardized data collection methods and criteria are critical to utilizing the vast collection of human experience as quality evidence to support regulatory approval.

关键词： Traditional Chinese medicine(TCM) Botanical drug Clinical trial Real-world evidence(RWE) Randomized-controlled trial(RCT)

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