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Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.
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Objective:To explore the price formation method and price standard in the big data diagnosis-intervention packet.Methods:The expenditure data and income data of 95 medical institutions in Shanghai in 2018 were used for analysis, including 33 municipal hospitals and 62 district hospitals. After using the standardized data of disease score, the medical institutions in the region were divided into four quadrants with the regional average of unit price per index and cost per index as the coordinate axis. The best quadrant of income and cost was found out, namely the high quality range. The geometric center was calculated in the high quality range, and the unit price per index of the geometric center was taken as the cost standard.Results:For the district hospitals, there were 20 hospitals in the first quadrant, 8 in the second quadrant, 24 in the third quadrant and 10 in the fourth quadrant; For the municipal hospitals, there were 7 hospitals in the first quadrant, 5 in the second quadrant, 12 in the third quadrant and 9 in the fourth quadrant. In the third quadrant, the average income and cost of medical institutions were lower than the average of the city, and the income could cover the cost. The third quadrant was the high quality range. The unit price per index of the third quadrant geometric center of district hospitals was 14 115.4 yuan, and that in municipal hospitals was 15 559.1 yuan, which could be used as the corresponding cost standard.Conclusions:The price discovery mechanism based on objective data and high-quality interval geometric center method can remove the impact of unreasonable charges or unreasonable behavior on medical income, and reflect the guidance of the standard price of medical insurance payment.
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One of the challenges to diagnosis-intervention packet is how to detect and avoid the institutional behavior of pursuing a higher score group. Based on the analysis method of big data, the authors analyzed the objective distribution characteristics of the treatment methods corresponding to a diagnosis, and compared the distribution of diseases with high and low scores in the region to find out the selection trend of treatment methods for the same diagnosis in various hospitals. Combined with hospital positioning, the authors found out whether there was a tendency of pursuing a higher score group. Scientific support will be provided for the reasonable payment of medical insurance expenses and the development planning of hospitals.
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Objective To observe the effect of stomach dampness decoction combed with quadruple therapy in the treatment of Hp related peptic ulcer .Methods 80 patients with Hp related peptic ulcer were randomly divided into two groups according to randomized block design , with 40 cases in each group .The control group received the quadruple therapy ,inculding orally pantoprazole enteric -coated tablets ,bismuth potassium citrate granules ,amoxicil-lin capsules,levofloxacin tablets.The study group was given Hewei Huashi decoction on the basis of the control group . The duration of treatment was 14 days and the effect was assessed after 1 month,the healing of ulcer and the improve-ment of clinical symptoms were observed .Results The ulcer healing rate in the study group ( 82 .5％) was higher than that in the control group (62.5％),the difference was statistically significant (χ2 =4.013,P=0.045).There was no statistically significant difference in total effective rate between the two groups ( 95.0％ vs.87.5％,χ2 =0.626,P=0.429).Before treatment,there were no statistically significant differences in the integral and the total integral of the imultaneous phenomenon between the two groups (all P>0.05).After treatment,the accompanying symptom scores and the total integral of the study group significantly reduced ,and the fullness[(0.28 ±1.03)points vs.(0.62 ±0.87)points,Z=-2.022],ructus[(0.40 ±0.67)points vs.(0.88 ±1.04)points,Z=-2.054],noisy [(0.25 ±0.49)points vs.(0.60 ±0.78)points,Z =-2.135],diarrhea[(0.25 ±0.49)points vs.(0.62 ± 0.71)points,Z=-2.642]and the total score[(2.52 ±1.71)points vs.(4.35 ±2.76)points,Z=-3.073]were better than those of the control group,and the differences were statistically significant (all P <0.05).The total effective rate of imultaneous phenomenon in the study group (97.5％) was higher than that of the control group (75.0％),and the difference was statistically significant (χ2 =6.746,P =0.009).Conclusion The stomach dampness decoction combined with quadruple therapy in the treatment of Hp related peptic ulcer has better curative effect,and it can more effectively improve the quality of healing and clinical symptoms .
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Shanghai is the earliest city in China for starting family doctor system at national level. It has actively explored the contract service mechanism between residents and family doctors. It has developed from "soft contract signing of guiding residents to understand, contact and gradually accept family doctor services" to the " main and close contracting using the comprehensive service from medical institutions". This paper systematically analyzed the implementation status in " one community health center, one district hospital and one municipal hospital (1 + 1 + 1)" contractservice system of family doctor in Shanghai from the aspects of adjustment background, design ideas, progress and obstacles of the policy. Based on the analysis of barriers to the policyimplementation, some suggestions were put forward including the improvement of the contract service system in order to increase the number and build the capacity of general practitioners, and the optimization of the existing payment distribution systems.
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Background and purpose:As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of med-ical institutions at all levels in Shanghai.Methods:From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.Results:Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of pri-mary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer.Conclusion:Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung can-cer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.
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Objective To collect the main contents of research in critical care medicine in foreign countries with the purpose of providing references for domestic research. Methods A two-way clustering analysis of foreign literature in PubMed concerning critical care medicine was conducted from 2004 to 2015 in this study, and the subjects of greatest interest were collected through the information visualization analysis pathway. Results Eight areas of most popular interest critical care medicine from January 1st, 2004 to November 8th, 2015 were found: blood sugar control in intensive care unit (ICU), acute kidney injury (AKI) and renal replacement therapy (RRT), nutritional support, the impact of ICU practice on reducing mortality, the assessment of critical patients, study of antibiotic resistance, the assessment of the life quality of critically ill patients, and home care and the rehabilitation of critically ill patients. According to the related literature, research in the field of critical care medicine has been growing steadily. USA, Japan, and Europe are the most developed countries or area in the field of critical care medicine. The four major research networks concerning research in critical care medicine were found: the control of blood glucose, monitor of circulatory function, nutritional support, and studies on AKI. Conclusion The most popular topics in research concerning critical care medicine research from 2004 to 2015 were blood glucose control, monitoring of circulatory function, nutritional support and AKI.
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Objective:To detect the expression levels of T cell immunoglobulin mucin-3 (Tim-3) in peripheral blood natural killer (NK) cells of patients with oral squamous cell carcinoma (OSCC) and to study their biological and clinical significance.Methods:The expression of Tim-3 in the CD3-CD56 + NK cells was examined in 72 patients with OSCC and 40 heathy controls (HC) by flow cytometry.The correlation of Tim-3 expression in NK cells with clinicopathological parameters was analyzed.Results:The proportion of CD3-CD56 + NK cells was significantly decreased in OSCC patients as compared with HC [(9.30 ± 2.52)％ vs (17.36 ± 3.15)％,P ＜ 0.001].The percentage of Tim-3 + CD3-CD56 + NK cells in OSCC patients was higher than that in HC [(14.35 ± 6.35) ％ vs (1.78 ± 0.86) ％,P ＜ 0.001].High percentage of Tim-3 + CD3-CD56 + NK cells was associated with cell differentiation,lymphatic metastasis and pathological stage of OSCC (P ＜ 0.01).Conclusion:Lower proportion of NK cells and higher level of Tim-3 in peripheral blood NK cells may play a role in the development of OSCC.
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The establishment of a scientific salary system is a key measure to improve the incentive and re-straint mechanisms, adjust and optimize the relations of the production, release the reform “bonus”, and is also an important health care reform today. In order to establish a scientific salary system of medical personnel adapting to the health industry characteristics, the paper makes an investigation on the salary level in the years of 2010—2012 in Shanghai, and analyzes the main problems of the present performance pay policy. On this basis, starting from the point of the health industry characteristics, the paper builds the salary system of medical personnel containing the comprehensive budget management, theoretical workload for approval, authorized personnel, performance appraisal and distribution, structural proportion within the industry, fund distribution management through the establishment of the salary level’s average wage and social linkage mechanism, and builds a theoretical framework on salary system of medical personnel in Shanghai.
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We have recently designed and synthesized several novel iminoquinone anticancer agents that have entered preclinical development for the treatment of human cancers. Herein we developed and validated a quantitative HPLC-MS/MS analytical method for one of the lead novel anticancer makaluvamine analog, TCBA-TPQ, and conducted a pharmacokinetic study in laboratory rats. Our results indicated that the HPLC-MS/MS method was precise, accurate, and specific. Using this method, we carried out in vitro and in vivo evaluations of the pharmacological properties of TCBA-TPQ and plasma pharmacokinetics in rats. Our results provide a basis for future preclinical and clinical development of this promising anticancer marine analog.
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Animals , Antineoplastic Agents , Blood , Pharmacokinetics , Chromatography, High Pressure Liquid , Methods , Pyrroles , Blood , Pharmacokinetics , Quinolones , Blood , Pharmacokinetics , Rats, Sprague-Dawley , Tandem Mass Spectrometry , MethodsABSTRACT
Teenage pregnancy carries serious impacts on adolescent health. This study aimed to examine the effects of pregnancy on adolescents and to explore how they cope with the problems they faced during the pregnancy. It involved 26 adolescents residing in a government shelter home in Kuala Lumpur. A self-administered questionnaire containing a mixture of open- and closed-ended questions was used. Among physical (sleeping problem and self-care problem), psychological (emotional difficulties and low self-efficacy) and social (stigma and discrimination, financial difficulty, friendship problem and school dropout) problems, emotional difficulties were the most common problems, whereas stigma and discrimination was the least common. Young adolescents aged less than 16 years old were significantly associated with poor self-care (p=0.01). To cope with their problems, the adolescents generally used avoidance, withdrawal, and social support, particularly from parents and peers. Doctors were the least popular among all. In conclusion, holistic and individualised care is needed. Strategies to reduce emotional problem experienced by pregnant adolescents should be implemented. The available healthcare services for teenage pregnancy should also be promoted.
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The paper described the necessity of the doctor-patient information exchange platform,and defects found in existing platforms. Such a platform is conducive to higher hospital informationization, better patient satisfaction, and better social and economic benefits of the hospital.The hospital may improve its quality of care and patient satisfaction by means of the platform
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<p><b>OBJECTIVE</b>To investigate the analgesic effects of Nourishing yin and Unblocking meridians Receipe (NUR) combined with opioid analgesics in managing cancer pain.</p><p><b>METHODS</b>All the patients enrolled were differentiated as of yin deficiency and meridian blocked syndrome type of TCM. Forty-one of them in the treated group were treated with NUR combined with opioid analgesics, while 43 of them in the control group were given opioid analgesics alone with successive 14 days as one treatment course for both groups.</p><p><b>RESULTS</b>The indexes of the treated group were superior to those in the control group as to the degree of pain-relieving, the therapeutic effect of analgesia, the occurrence frequency of cancer pain every day and its duration each time, the analgesic initial time, and the quality of life.</p><p><b>CONCLUSION</b>NUR combined with opioid analgesics in cancer pain management was more effective than opioid analgesics alone.</p>
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Adult , Female , Humans , Male , Middle Aged , Analgesics, Opioid , Drug Therapy, Combination , Drugs, Chinese Herbal , Meridians , Morphine , Neoplasms , Pain , Drug Therapy , Pain Measurement , Treatment Outcome , Yin Deficiency , Drug Therapy , Yin-YangABSTRACT
<p><b>OBJECTIVE</b>To study the relationships between intrahepatic HBV DNA level and serum HBV DNA level, between intrahepatic HBV DNA level and hepatitis B e antigen (HBeAg) level in patients with chronic hepatitis B (CHB), and assess the valuation of pretreatment liver HBV DNA level in antivirus therapy.</p><p><b>METHODS</b>Liver specimens taken from 41 HBeAg-positive CHB patients before antivirus treatment were divided into two parts, one for histological examination, and the other for intrahepatic HBV DNA quantified detection by PCR-fluorescence. At the same time, serum levels of HBV DNA and HBeAg were detected. The patients were classified into two groups according to the pretreatment intrahepatic HBV DNA level (< or = 10(4)fg/cm(3) in group A, >10(4)fg/cm(3) in group B) and accepted interferon alpha-1b (3MU every day for 26 weeks) in combination with lamivudine (100mg per day for 52 weeks). During the treatment, the serum levels of alanine aminotransferase (ALT), HBV DNA and HBeAg seroconversion rate were monitored.</p><p><b>RESULTS</b>(1) The level of liver HBV DNA was much higher than that of serum HBV DNA (4.081 +/-1.127 vs 3.163 +/-1.010, t = 2.218, P < 0.05). Liver HBV DNA level had positive correlation to serum HBV DNA level (r = 0.840, t = 4.322, P < 0.001) and serum HBeAg level (r = 0.459, t = 3.056, P < 0.005). (2) Intrahepatic HBV DNA level was negative correlation to the severity of liver damage (chi(2) = 3.874, P < 0.05). (3) Serum HBV DNA level in all the patients reduced remarkedly after therapy, especially in group A. At the end of 52 weeks, the rates of HBeAg and anti-HBe seroconversion in group A were higher than those in group B (68.4% vs 36.4%, chi(2) = 4.194, P < 0.05; 73.7% vs 40.9%, chi(2) = 4.447, P<0.05).</p><p><b>CONCLUSIONS</b>Intrahepatic HBV DNA is a more valuable marker than serum HBV DNA or HBeAg to assess HBV replication, and can reflect the status of body immunity indirectly. It may be a useful indicator for the efficacy of antivirus treatment.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Antiviral Agents , Therapeutic Uses , DNA, Viral , Blood , Hepatitis B e Antigens , Blood , Hepatitis B virus , Genetics , Hepatitis B, Chronic , Drug Therapy , Virology , Interferon-alpha , Therapeutic Uses , Lamivudine , Therapeutic Uses , Liver , Virology , Treatment Outcome , Viral Load , Virus ReplicationABSTRACT
In order to arouse the working enthusiasm of the entire staff and give expression to the value of labor and skills, our hospital has implemented reform in the distribution system. Bonus given to clinical departments is linked both to the amount and quality of work and to economic profits; bonus to medico technical departments is given by means of deducting a percentage from the income and expenditure surplus in a way of progressive decrease; bonus given to functional departments is equivalent to 90% of the average bonus given to medical service departments; and bonus to logistical service departments is given, if possible, by the piece and mark. As a result of the reform, the distribution system has become more rational, the working enthusiasm and efficiency of the staff have been enhanced, operational income and income structure have improved, and social benefits bave been raised, with the satisfaction rate reaching over 90%. Of course, there still exist some difficulties in the reform.