ABSTRACT
Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , China , Health Expenditures , Hospitalization , Inpatients , Terminally IllABSTRACT
Objective The present study was conducted to investigate the perception of haze among pregnant women and to provide basis for developing interventions.Methods A pregnant woman who has been living in Shunyi district for at least six months has been selected as the subject of investigation. A self-designed questionnaire was used to conduct field investigation. Results A total of 320 questionnaires were collected, including 308 valid questionnaires and 96.25% effective questionnaires. In terms of the cognitive aspects of haze, pregnant women think that there is a serious harm to the respiratory system, and 52.27%(161/308)of pregnant women think that the haze is harmful to the cardiovascular system. In the area of haze protection, 79.22%(244/308)of pregnant women wear masks when they go out. Pregnant women who are in the haze of 100.00% (308/308)will reduce window ventilation time. Access to information about haze information and protection knowledge is mainly including mobile phones(83.12%), network(44.16%)and TV(23.38%). The multi-factor logistic regression analysis showed that the haze was harmful to the health of the fetus (OR=0.12, 95%CI: 0.031-0.446), which was the influencing factor of the pregnant women's haze protection measures. Conclusion Pregnant women in Shunyi District have higher awareness of haze knowledge, and the influencing fact of the measures on the haze weather is the cognition that the haze is harmful to the health of the fetus.
ABSTRACT
<p><b>Background</b>Lupus nephritis (LN) is classified by renal biopsy into proliferative and nonproliferative forms, with distinct prognoses, but renal biopsy is not available for every LN patient. The present study aimed to establish an alternate tool by building a predictive model to evaluate the probability of proliferative LN.</p><p><b>Methods</b>In this retrospective cohort with biopsy-proven LN, 382 patients in development cohort, 193 in internal validation cohort, and 164 newly diagnosed patients in external validation cohort were selected. Logistic regression model was established, and the concordance statistics (C-statistics), Akaike information criterion (AIC), integrated discrimination improvement, Hosmer-Lemeshow test, and net reclassification improvement were calculated to evaluate the performance and validation of models.</p><p><b>Results</b>The prevalence of proliferative LN was 77.7% in the whole cohort. A model, including age, gender, systolic blood pressure, hemoglobin, proteinuria, hematuria, and serum C3, performed well on good-of-fit and discrimination in the development chohort to predict the risk of proliferative LN (291 for AIC and 0.84 for C-statistics). In the internal and external validation cohorts, this model showed good capability for discrimination and calibration (0.84 and 0.82 for C-statistics, and 0.99 and 0.75 for P values, respectively).</p><p><b>Conclusion</b>This study developed and validated a model including demographic and clinical indices to evaluate the probability of presenting proliferative LN to guide therapeutic decisions and outcomes.</p>