ABSTRACT
Objective:To evaluate and compare the inpatient medical services of secondary public and private general hospitals by using disease risk adjustment model, and to explore the application of disease risk adjustment model in medical service evaluation of different ownership hospitals.Methods:Based on 1 032 865 front pages of medical records in Chengdu in 2017 and 2018, a regression model with mortality, average length of stay, total hospitalization expenses, medical service fees, drug costs and surgical consumables costs as dependent variables and related influencing factors as independent variables was established by using disease management intelligent analytic and evaluation system. The risk adjusted case mix index(ACMI) was calculated. The mortality, average length of stay, hospitalization expenses and other indicators were predicted. The ratio of observed value to expected value(O/E value) of each index in public and private secondary general hospitals was obtained and compared.Results:The ACMI value of secondary public general hospital was 4.63, slightly higher than that of private hospitals(4.55). The technical difficulty and resource consumption of the public hospitals were slightly higher than that of the private hospitals.From the O/E value, the management of disease mortality, medical service fees and inpatient drug costs of secondary public hospitals was generally good, and the O/E values of hospitalization expenses of each secondary private general hospital were quite different, and there was a possibility that the costs were unreasonable. The O/E value of surgical consumables cost in secondary public general hospital was 1.54, and there was room for improvement in cost management.Conclusions:The disease risk adjustment model fully considers the characteristics of different types and severity of diseases in different institutions, which can not be simply compared. Based on individual cases, it realizes the comparability of different ownership hospitals, and provides a new means for the evaluation of medical service ability and quality.
ABSTRACT
ObjectiveTo explore the relation of VEGF-C and CD44V6 expression with cervical lymph metastases in papillary thyroid carcinoma.MethodsThe expression of VEGF-C and CD44V6 in 80 specimens of papillary thyroid carcinoma were evaluated with SP immunohistochemical methods. Lymphangiogenesis was examined by immunohistochemical staining with the specific D2-40 antibody and evaluated by lymphatic vessel density(LVD).In all the 80 cases,there were 38 cases with cervical lymph node metastases and 42 cases without cervical lymph node metastasis. ResultsThe positive expression rates of VEGF-C and CD44V6 in the cases with cervical metastases were 86.84 ％ (33/38) and 81.58 ％ (31/38) respectively,and in the cases without cervical lymph metastases were 61.90 ％ (26/42) and 52.38 ％ (22/42) respectively.There were significant differences in the positive expression rates of VEGF-C and CD44V6between two groups(P＜0.05). In the cases with lymph node metastases,there were positive correlations between VEGF-C and CD44V6 expression(r=0.525,P＜0.0l).Conclusion VEGF-C and CD44V6 play important roles in lymph metastasis and invasion of papillary thyroid carcinoma.VEGF-C and CD44V6 can be considered as a marker of pathological and biological behavior of papillary thyroid carcinoma.