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Analysis of inpatient Bed Allocation Equity and Utilization in the City Community health service Center of China

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2010年第2期30卷 141-144页

作者：许静吴妮娜金生国王芳王云霞刘利群卢祖洵 Department of Social Medicine and health Management School of Public HealthTongji Medical CollegeHuazhong University of Science and Technology School of health Administration and Education of Capital Medical University Division of Maternal and Child health and Community health Ministry of Health of the People's Republic of China Gerontology Medicine Research Institute of Liyuan Hospital Tongji Medical CollegeHuazhong University of Science and Technology

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community health service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

关键词： community health service center IB allocation utilization China

Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

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World Journal of Psychiatry 2024年第10期14卷 1521-1537页

作者： Peter Phiri Laura Pemberton Yang Liu Xiaojie Yang Joe Salmon Isabel Boulter Sana Sajid Jackie Clarke Andy McMillan Jian Qing Shi Gayathri Delanerolle Department of Research&Innovation Southern Health National Health Service Foundation TrustSouthampton SO303JBUnited Kingdom Department of Statistics and Data Science Southern University of Science and TechnologyShenzhen 518055Guangdong ProvinceChina School of Statistics and Mathematics Yunnan University of Finance and EconomicsKunming 650221Yunnan ProvinceChina Virti healthcare KeynshamBristol BS311SNUnited Kingdom Neuromodulation Centre Southern Health National Health Service Foundation TrustSouthampton SO140YGUnited Kingdom National health service Talking Therapies Southern Health National Health Service Foundation TrustSouthampton SO509FHUnited Kingdom

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any *** is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the *** interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive *** could also aid staff to and change current *** To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP *** A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern health National health service Foundation Trust,United *** VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric *** measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action *** Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR *** were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over *** respondents recorded System Usability Scale scores above 70,with an average score of *** was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability ob

关键词： Virtual reality Restrictive practices inpatient wards Restraint Isolation Rapid tranquilisation Covert medication Procedural restrictions health professions training

Effects of Integrated Case Payment on Medical Expenditure and Readmission of inpatients with Chronic Obstructive Pulmonary Disease： A Nonrandomized, Comparative Study in Xi County, China

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Current Medical Science 2018年第3期38卷 558-566页

作者： Meng SHI Jing WANG Liang ZHANG Yan YAN Yu-dong MIAO Xiang ZHANG School of Medicine and health Management Tongji Medical College Huazhong University of Science and TechnologyWuhan 430030 China School of health Policy and Management Nanjing Medical University Nanjing 211166 China Research Center for Rural health service Key Research Institute of Humanities & Social Sciences of Hubei ProvincialDepartment of Education Wuhan 430030 China

In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social health Insurance system. However, the payment mode of Social health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease （COPD）, a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. inpatients with COPD before （n=1569） and after the integrated case payment reform （n=4764） were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment （including price-cap case payment and fixed-reimbursement case payment） and clinical pathway （including clinical pathway A, clinical pathway B and clinical pathway C）. Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment （β=2382.988, P〈0.001） and fixed-reimbursement case payment β=2613.564, P〈0.001）, and clinical pathway C （β=1996.467, P〈0.001） were risk factors of per capita total medical expenses. Clinical pathway A （β=-1443.409, P〈0.001） and clinical pathway B （β=-1583.791, P〈0.001） were protective factors. The interactive effects of case payment with hospital level （β=0.710, P〈0.001） lowered the readmission rate within 30 days. Meanwhile, clinical pathways A （β=18.949, P〈0.001）, B （β=-19.752, P〈0.001） and C （β=-1.882, P〈0.1） were associated with the rate increase. The findings revealed that integrated case payment ensured th

关键词： chronic obstructive pulmonary disease integrated case payment clinical pathway Xi county

Patient Safety in the Use of Mechanical Restraints: Regulatory Compliance among Hospitals in the City of Buenos Aires and Proposal for Its Improvement

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Open Journal of Emergency Medicine 2024年第2期12卷 33-39页

作者： Martín Javier Mazzoglio y Nabar Sergio Giordano Edgardo Knopoff Lorena Onofrio Oscar Agustín Porta Romina Rodríguez Emergency service Torcuato de Alvear Psychiatric Emergency Hospital Buenos Aires Argentina Department of Psychiatry and mental health Faculty of Medicine University of Buenos Aires Buenos Aires Argentina

Introduction: Mechanical or physical restraint is an exceptional therapeutic resource to immobilize a subject and thus guarantee the safety of the patient and/or third parties in the face of high-risk behaviors, but it entails multiple crossings (bioethical, philosophical, medical, psychological, legal). Framed in the so-called “safety culture” developed by the WHO, based on the Protocol for its implementation of the CABA and attentive to its frequent use in CABA by different hospital services (medical clinic, geriatrics, intensive care and medical guards) we consider it necessary its study in terms of compliance with the risks it entails and its management. Objectives: Identify regulatory compliance with the GCABA Mechanical restraint (MR) Protocol from a patient safety perspective, as well as describe the clinical and medicolegal aspects, and propose the usefulness of a tool for its management and control. Methodology: Observational, descriptive, transversal and prospective work through the analysis of Clinical Records with indication of MR using a rubric-type form. 177 cases were analyzed between September-November 2023 from three hospitals of the Government of the City of Buenos Aires, statistical parameters were applied and graphs were made. Results: Only 12.99% complied with the Protocol. In the mental health specialized hospital compliance was almost 5 times greater than in the general one, and in the emergency services compliance was 12 times greater than in inpatient services. We found that the start or end time of MR was not recorded and only 43% described the causes/justifications for the indication (mostly in Emergency and Specialized hospitals), with the MR average time being shorter in Emergency. Conclusions: Only 1.3 out of 10 patients reliably completed the Protocol and it was mostly in the mental health specialized hospital and the emergency services. The results show non-compliance behavior in the application and management of the risk that the use

关键词： Mechanical Containment Patient Safety Injuries in Custody Buenos Aires City Check List

Implications of hepatic dysfunction in Kawasaki disease:Time-related changes in aspartate aminotransferase, alanine aminotransferase,total bilirubin,and C-reactive protein levels

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Pediatric Investigation 2019年第1期3卷 19-26页

作者： Yasuhiko Tomita Takashi Fukaya Yasuko Yamaura Rie Tsujiguchi Haruko Muratani Maki Shimaya Hyogo health service Association Center for Health Evaluation and PromotionKobeHyogoJapan

Importance:The cause of the hepatic dysfunction that commonly accompanies Kawasaki disease(KD)remains ***:We tried to clarify the cause of the hepatic ***:A total of 381 consecutive patients with acute KD,who had undergone inpatient treatment with intravenous immunoglobulin until the 7th day of illness,were divided into a group of 199 patients with an alanine aminotransferase(ALT)level≥40 IU/L on admission(group I),a group of 52 patients with an ALT level≥40 IU/L at some point after admission(group II),and a group of 130 patients with ALT levels consistently<40 IU/L throughout hospitalization(group III).Aspartate aminotransferase(AST),ALT,total bilirubin(T-Bil),and C-reactive protein(CRP)levels were analyzed over time,and time-courses were ***:In the initial stage of illness,in group I,AST,ALT,T-Bil peaked on days 1-3,and AST tended to improve significantly on the 4th day(P<0.001).T-Bil improved on day 5(P<0.01),and ALT improved significantly on day 6(P<0.001).CRP increased every day up to day 6(P<0.001).In group II,AST and ALT increased after admission,and thereafter CRP increased,then *** frequency of use of aspirin and aspirin doses did not differ significantly in the three ***:Recovery from liver dysfunction occurred in the initial stage of illness in group I-within the period of CRP exacerbation,which is an indicator of systemic inflammation.

关键词： Kawasaki disease Dysbiosis Fecal calprotectin Gut inflammation Pathogenesis Portal vein

Comparison of Olanzapine versus Other Second-Generation Antipsychotics in the Improvement of Insight and Medication Discontinuation Rate in Schizophrenia

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上海精神医学 2018年第3期30卷 178-187页

作者： Hongbo HE Yanling ZHOU Mingzhe YANG Xiongxiong LI Yu-Tao XIANG Jiandong LUO Department of Psychiatry The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou Mental Health Center Guangzhou China Department of Pharmacology Guangzhou Medical University Guangzhou China Unit of Psychiatry Faculty of Health Sciences University of Macao Macao SAR China

UNASSIGNED:In the last decade, olanzapine became widely used in mental health service worldwide even after being criticized for its metabolic side effects. Patients with schizophrenia on olanzapine were usually found to stay on their medications longer than the other second-generation antipsychotics (SGAs) except clozapine. The reason for this is unknown.;UNASSIGNED:This prospective study compared the influences of olanzapine and other SGAs except clozapine on improving insight and medication discontinuation rate in schizophrenia.;UNASSIGNED:A total of 148 patients with schizophrenia medically indicated for initiation of treatment with olanzapine or other SGAs were evaluated for symptoms, insight, attitudes toward medication, side effects, body weight and fasting lipid and glucose parameters at admission and before discharge, and follow-up calls one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not.;UNASSIGNED:After an average of 72.8 days of inpatient treatment, the olanzapine and other SGAs group exhibited similar levels of symptom improvement with an average reduction of 28.7 in the Positive and Negative Syndrome Scale (PANSS) total score. The Olanzapine group exhibited better improvement in insight assessed using the G12 item of PANSS and Insight and Treatment Attitudes Questionnaire (ITAQ), more metabolic side effects indexed with total cholesterol, triglycerides levels and weight gain, and a lower medication discontinuation rate than the other SGAs group.;UNASSIGNED:Although general symptom improvement was similar, olanzapine significantly improved insight and presented less medication discontinuation compared to other SGAs, which might partially explain why patients on olanzapine stayed longer on their medications.

关键词：精神分裂症第二代新陈代谢 SGA 类脂化合物副作用心理健康世界范围

Effect of Physical Activity on Hospital service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China

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Current Medical Science 2019年第3期39卷 483-492页

作者： Fang WANG Liu-yi ZHANG Ping ZHANG Yao CHENG Bei-zhu YE Mei-an HE Huan GUO Xiao-min ZHANG Jing YUAN Wei-hong CHEN You-jie WANG Ping YAO Sheng WEI Yi-mei ZHU Yuan LIANG Department of Social Medicine and health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and health School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Department of Epidemiology and Biostatistics and the Ministry of Education (MOE) Key Lab of Environment and health School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China School of Media Communication and Sociology University of Leicester Leicester LEI 7JA UK

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

关键词： physical activity coronary heart disease hospital service use healthcare expenditure

Expenditure of hospital care on cancer in China, from 2011 to 2015

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Chinese Journal of Cancer Research 2017年第3期29卷 253-262页

作者： Yue Cai Ming Xue Wanqing Chen Maogui Hu Zhiwen Miao Lan Lan Rongshou Zheng Qun Meng Center for health Statistics and Information National Health and Family Planning Commission National Central Cancer Registry National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College State Key Laboratory of Resources and Environmental Information System Institute of Geographic Sciences and Natural Resources Research Chinese Academy of Sciences West China School of Public health Sichuan University

Objective: A solid understanding of levels and trends of spending on cancer is important to evaluate whether our healthcare resources were wisely spent and to prioritize future resources for cancer treatment and prevention. However, studies on economic burden of cancers in China are scant and the results are inconsistent. Methods: The Chinese hospital information database and nearly 350 million inpatient medical record data were used. As the ratios of cancer inpatient payments to total inpatient payments were mainly influenced by the grades and sites of hospitals, the estimates of payments of cancer inpatients in this study were stratified by hospital grades and provinces. Only the payments of cancer inpatients happened in grade 2, grade 3 and specialized cancer hospitals were included in the analyses. The total medical payments of cancers in China were estimated based on the ratios of outpatient payments to inpatient payments in specialized cancer hospitals. Results: From 2011 to 2015, the payments of cancer inpatients in China have increased by 84.1% and the total inpatient payments reached 177.1 billion RMB in 2015, accounting for 4.3% of the total health expenditure in China. Based on the ratio of outpatient payments to inpatient payments, the total payments on cancer treatments in China were estimated to be 221.4 billion RMB in 2015. Among different cancer types, the highest payments were the treatment of trachea, bronchus and lung cancer. The major cancer inpatient payments (67.1% in 2015) spent in grade 3 general hospitals and this ratio increased continually from 2011 to 2015. The expenditure of cancer treatments also varies by region with the major expenditure in the eastern region of China. Conclusions: This study estimated the total payments of cancer treatments in China and analyzed how the money was spent on cancer treatments in the recent 5 years, which would provide information for decision makings on the allocation of resources to service provisionin

关键词： Cancer payments expenditure economic burden

A study on the correlation between function motivation and professional identity among nursing volunteers

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Journal of Integrative Nursing 2021年第4期3卷 165-169页

作者： Juan XU Wenjun HAO Hui YANG Xuanxuan LI Department of inpatient Shanxi Provincial People’s HospitalYingze DistrictTaiyuan CityShanxi ProvinceChina School of Nursing Shanxi University of Chinese MedicineTaiyuan CityShanxi ProvinceChina Department of Nursing First Hospital of Shanxi Medical UniversityTaiyuan CityShanxi ProvinceChina

Objective:The objective of this study is to understand the status quo of function motivation and professional identity among nursing volunteers and explore the correlation between the *** and Methods:A total of 3375 nursing volunteers from Nightingale Volunteer service Group in Shanxi Province were investigated by using Occupational Identity Scale and Volunteer Functional Motivation ***:A total of 3375 questionnaires were issued and 3330 were recovered,among which 3324 were valid,with an effective recovery rate of 99.82%(3324/3330).The overall score of professional identity of nurses was 110.31±18.71,and the score of each dimension was 32.17±6.62 for professional cognitive evaluation dimension,22.77±3.74 for professional social support,21.31±4.09 for professional social skills,22.78±3.79 for professional frustration coping,and 11.32±2.03 for professional *** total score of function motivation was 157.12±*** above five dimensions of nurse’s professional identity scale were positively correlated with the total score of function motivation of nursing volunteers(r=0.044,0.035,0.034,0.035,and 0.042,respectively,all Pservice projects,enhance their professional identity,and make them better give back nursing professional skills to the society.

关键词： Functional motivation nurse professional identity volunteers