The Reference and Enlightenment of APG Grouping and Payment System in the United States for China's Ambulatory Care Payment Reform / 中国医院管理

Objective It aims to analyze the grouping methods,payment standard calculation process,and cost settlement rules of ambulatory payment groups(APG)system in the United States.Additionally,it seeks to summarize the technical advantages and implementation key points of APG,providing reference for the ambulatory care payment reform in China.Methods Employing a literature research approach,this study dissects the payment technology and implementation process of APG.A preliminary comparison is made with the practices of APG pilot cities in China.Results The APG 3.18 version catalog comprises 13 types,61 categories,and 666 groups.One APG case can be classified into multiple APG groups,and by applying rules such as consolidation,packaging,and discounting,the final payment amount is calculated.Conclusion The APG payment technology aligns with the characteristics of outpatient health services,offering flexible payment methods and incentivizing healthcare institutions to provide efficient services.This holds significant reference value for the ambulatory care payment reform in China.The key points of APG implementation include improving the quality of outpatient data,localizing grouping and payment rules,establishing a regulatory assessment indicator system,and ensuring alignment with inpatient payments.

Prevalência de sintomas depressivos em pacientes de serviços ambulatoriais de clínica médica / Prevalence of depressive symptoms in patients of medical ambulatory services

RESUMO Objetivo Estimar a prevalência de sintomas depressivos em pacientes de ambulatórios de clínica médica no Hospital Universitário Lauro Wanderley, em 2018. Métodos Aplicação de um questionário sociodemográfico e da escala de depressão de Hamilton em um período de dois meses; 101 pacientes foram devidamente entrevistados. Resultados Observou-se que 61,4% da amostra classifica-se entre ligeiramente e gravemente deprimida, sendo 78% dos pacientes da reumatologia, 63% da cardiologia e 48% da endocrinologia. Dos pacientes abordados, 34,6% praticam atividade física pelo menos três vezes por semana, 53,5% fazem ou já fizeram uso de medicação para dormir, 25,7% já fizeram tratamento psiquiátrico e 4,9% o fazem atualmente, em contrapartida 29,7% fazem uso de algum psicotrópico. Dos psicotrópicos, o mais utilizado foi o diazepam (16,7%). Verificaram-se as seguintes associações: pacientes ligeiramente a gravemente deprimidos não praticavam atividades físicas, já faziam tratamento de saúde e tinham histórico de tratamento psiquiátrico; a reumatologia apresentou mais pacientes com algum grau de depressão. Dos 27 que disseram ter sono ruim, 78% usavam medicamento para dormir e 63%, psicotrópicos; 60% não praticavam atividade física e 81% eram ligeiramente a gravemente deprimidos. Sintomas somáticos foram os mais relatados na escala de Hamilton. Conclusão Existe alta prevalência de sintomas depressivos em pacientes dos ambulatórios de clínica médica, com destaque para as doenças cardiovasculares, endocrinológicas e reumatológicas. Percebe-se que houve grande destaque para os sintomas somáticos, o que pode explicar a grande quantidade de entrevistados que não são acompanhados por psiquiatra e tratados apenas com sintomáticos.

ABSTRACT Objective Estimate the prevalence of depressive symptoms in ambulatory of medical clinics at Lauro Wanderley University Hospital in 2018. Methods Application of a sociodemographic questionnaire and the Hamilton Depression Rating Scale in a 2-month period, where 101 patients were interviewed. Results It was observed that 61.4% of the sample is classified as mildly and severely depressed, with 78% of rheumatology patients, 63% of cardiology and 48% of endocrinology. Of the patients treated 34.6% practice physical activity at least three times a week, 53.5% use or had used sleeping medication, 25.7% have psychiatric treatment and 4.9% currently do, in contrast 29.7% use some psychotropic. Of the psychotropics, the most used was Diazepam (16.7%). The following associations were found: slightly depressed patients did not practice physical activities, were already receiving health treatment and had a history of psychiatric treatment; rheumatology showed more patients with some degree of depression. Of the 27 who reported poor sleep, 78% used sleeping medication and 63% psychotropic, 60% did not practice physical activity and 81% were slightly depressed. Somatic symptoms were the most reported on the Hamilton scale. Conclusion There is a high prevalence of depressive symptoms in patients of medical ambulatory services, especially cardiovascular, endocrinological and rheumatologic diseases. It is noticed that there was a great emphasis on somatic symptoms, which may explain the large number of respondents who are not accompanied by psychiatrist and treated only with symptomatic.

Características de pacientes asmáticos mexicanos atendidos en consulta externa / Characteristics of Mexican asthmatic subjects attending an outpatient service

Background. Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. Objective.To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. Methods.Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. Results. A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. Conclusion.Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Antecedentes. A pesar de que en México existe una alta prevalencia de asma, hay pocos estudios que describan las características generales de estos pacientes. Objetivo. Conocer el perfil sociodemográfico, clínico y funcional respiratorio de pacientes asmáticos que acuden por primera vez a consulta externa de un hospital de tercer nivel de atención, así como los tratamientos recibidos y su tasa de abandono. Métodos. Se estudiaron, prospectivamente, sujetos asmáticos adolescentes y adultos, atendidos de febrero del 2000 a noviembre del 2002 en el servicio de consulta externa del Instituto Nacional de Enfermedades Respiratorias, de la ciudad de México. Se recabó información sociodemográfica y se realizó evaluación clínica y por espirometría. La gravedad del asma se clasificó de acuerdo con criterios internacionales. Resultados. Se incluyeron 1,403 pacientes de 12 a 82 años de edad, con predominio del sexo femenino. El 88.7% de los pacientes tenían formas leves de la enfermedad, 10% asma moderada, y 1.3% asma grave. El 21.4% no había recibido tratamiento antiasmático. Entre los demás, cerca de una tercera parte recibió corticosteroides, independientemente de la gravedad del asma, indicando sobretratamiento del asma intermitente y subtratamiento de las formas persistentes. Encontramos una alta tasa de deserción (65.7%). Una respuesta positiva a la prueba con broncodilatador se observó en 30.3% de los pacientes con asma intermitente, cifra que se elevó a cerca de 67% en las formas moderada y grave. Conclusión. Entre los pacientes asmáticos que acuden a consulta externa, predominan las formas leves, detectándose que todavía existe una alta frecuencia del uso inadecuado de los corticosteroides.

Ansiedade e mecanismos de coping utilizados por pacientes cirúrgicos ambulatoriais / Ansiedad y mecanismos de coping utilizados por pacientes quirúrgicos de consulta externa / Anxiety and coping in ambulatory surgical patients

Os objetivos deste estudo foram identificar o estado de ansiedade e os mecanismos de coping utilizados por pacientes cirúrgicos ambulatoriais no período pré-operatório, suas manifestações clínicas e respectivas correlações. Os resultados obtidos identificam que a amostra de 40 pacientes apresentou baixa ansiedade e o mecanismo de coping mais utilizado foi o suporte social, porém, não obtivemos relação estatisticamente significante entre estado de ansiedade e mecanismos de coping e alterações clínicas.

The goals of this study were to identify the anxiety state in surgical ambulatory patients in the pre-operative period, the coping mechanisms employed, their clinical manifestation, and to verify the influence of state anxiety during the pre-operative period. The results showed that patients exhibited little anxiety and there was no significantly statistical correlation between pre-operative anxiety state, coping mechanisms and clinical changes.

Este estudio tuvo como objetivos identificar el estado de ansiedad y los mecanismos de "coping" utilizados por pacientes quirúrgicos de consulta externa en el período pre-operatorio, sus manifestaciones clínicas y respectivas correlaciones. Los resultados obtenidos identifican que la muestra de 40 pacientes presentó baja ansiedad y el mecanismo de coping más utilizado fue el soporte social, sin embargo, no se obtuvo relación estadísticamente significativa entre el estado de ansiedad y mecanismos de "coping" y alteraciones clínicas.