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Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the expression of Notch signaling receptors Notchl, Notch3 and its ligand Jaggedl, Jagged2 in tongue squamous cell carcinoma (TSCC).</p><p><b>METHODS</b>mRNA and protein expression levels of tissue samples from 74 cases of tongue cancer patients and human tongue cell line Cal-27 were detected by reverse transcriptase-polymerase chain reaction (RT-PCR), immunohistochemistry and Western blot. Its relationship with cell proliferation and clinical pathology was analyzed.</p><p><b>RESULTS</b>mRNA and protein expression were detected in tongue cancer tissues, adjacent tissues and cell lines. Notchl and Notch3 protein expression in tongue cancer was higher than the adjacent tissues. Jaggedl and Jagged2 protein expression in tongue cancer and adjacent tissues had no difference. Notchl and Notch3 protein had correlation with tongue cancer clinical staging. Pathway protein expression had no correlation with pathological grade, age, gender. Notchl protein expression in lymph node metastasis-positive cases was higher than in lymph node metastasis-negative cases. The expression of Notch3 and Jagged2 had correlation. Jaggedl expression grade in metastasis-positive cases was higher than in negative cases.</p><p><b>CONCLUSION</b>Notch signaling molecules have active expression in TSCC and may play important roles in tongue cancer development.</p>