Impact analysis of emergency intervention on 120 ambulance dispatchers in Chongqing city with regression discontinuity designs / 中华急诊医学杂志

Objective:To explore the impact of emergency response to public health emergencies on the efficiency of pre-hospital emergency work, and study the degree of impact on 120 ambulance dispatchers in Chongqing city during pre-periods and post-periods of the emergency intervention.Methods:Taking 120 phone answering and ambulance operation efficiency as the research subjects, we collected pre-hospital emergency case data from a city's emergency medical center, covering the period from November 10, 2021 to January 6, 2023. The cases were divided into groups according to the time periods of emergency response. A regression discontinuity design method was employed to compare the response of emergency intervention to the predictions (virtual cases) without the emergency intervention, obtaining the average intervention effect.Results:During the study period of 27 days, the number of 120 calls picked up within 10 seconds increased from 11 000 to 19 000, but the answering rate slightly decreased within 10 seconds. The vacancy rate of 120 ambulances during emergency response decreased from 0.39% to 0.20%, but the completion rate within 18 minutes decreased from 72% to 30%. In this particular emergency response period, the number of patient complaints (such as high fever and difficulty breathing) increased compared to the pre-period of emergency response.Conclusion:Emergency response significantly impacts pre-hospital emergency work such as emergency phone answering and ambulance operation efficiency. This study provides empirical research results and decision-making support for urban emergency medical services to respond to public health emergencies.

A Study on the Impact of National Volume-based Procurement on Inpatient Medical Costs / 中国卫生经济

Objective:To study the impact of the national volume-based procurement policy on inpatient medical costs.Methods:Firstly,a descriptive analysis on the completion of the procurement volume of drugs in the hospital was carried out,and furthermore,using the data on the medical costs of inpatients before and after the implementation of the policy,conducted statistics on changes in the structure of patients'medical expenses.Taking the time of the first day of using the volume-based procurement drugs as the breakpoint,a sharp regression discontinuity model was constructed to compare the changes in the different categories of costs.Re-sults:There is still room for improvement in the use of volume-based procurement drugs in the hospital.After the use of those drugs,in addition to the cost of comprehensive services and consumables rose by 1.01 and 3.07 percentage points respectively,the rest of the categories of costs were on a downward trend,the per capita total medical costs and drug costs of inpatients fell by 644.58 yuan and 300.19 yuan respectively.In addition,the average hospital stay of patients decreased significantly after the implementation of the poli-cy.Conclusion:The national volume-based procurement policy has achieved certain results,but there is a need to set more reason-able procurement volume targets and to adjust cost control measures in a comprehensive manner to further optimize the structure of medical costs.

Milk supplementation increases mid-upper arm circumference and haemoglobin level among pregnant women in Kupang, Indonesia: Evidence from a regression discontinuity design

@#Introduction: The high prevalence of chronic energy deficiency (CED) and anaemia among pregnant women in Indonesia is worrying. Nusa Tenggara Timur (NTT) is one of the provinces in Indonesia with the highest prevalence of CED. This study aimed to determine the effect of fortified milk supplementation on changes in mid-upper arm circumference (MUAC) and haemoglobin level among pregnant women. Methods: This quasi-experimental study was conducted in three locations of Community Health Centers in NTT from May to August 2019. Purposive sampling was used to recruit 69 pregnant women who were divided into two groups based on haemoglobin levels; the intervention group consisted of 31 pregnant women with haemoglobin levels below 11 g/dL, and control group consisted of 38 pregnant women with haemoglobin levels above 11 g/dL. Intervention group was provided with fortified milk supplementation, while control group received education about prevention of CED and anaemia. Data were analysed using regression discontinuity design with haemoglobin of 11 g/dL as cut-off. Results: Using regression discontinuity method, we were able to determine the effect of milk supplementation based on haemoglobin levels and confirm the result that milk supplementation significantly increased MUAC by 4.69 cm. Despite no discontinuity found, a positive increase of 0.98 g/dL in haemoglobin level was important to note. Conclusion: Milk supplementation of 300 kcal/day for three months significantly increased MUAC and to some extent, increased haemoglobin level. Thus, it should be considered when planning nutrition programmes to improve the nutritional status of pregnant women.

Study on the influence of Beijing Medical Reform on the hospitalization expenses of medical and surgical patients in a hospital / 中华医院管理杂志

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.