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Objective:To investigate the current status of medical record coders and their resignation tendency, and put forward suggestions for the training and team building of medical record coders.Methods:From April to May 2020, a questionnaire survey was conducted among the medical record coders in 27 DRG payment pilot hospitals in Anyang, Henan. Statistical analysis was conducted on the profile of the medical case department, basic personal information, professional quality, job satisfaction and resignation intention. Kendall coefficient was used to analyze the factors related to the resignation intention.Results:There were 98 coders in the surveyed hospitals, including 43 full-time coders and 55 part-time coders. Eighty-three valid questionnaires were recovered, and the effective recovery rate was 84.7%. Among them, 29(34.9%) had education level of junior college or below, 51(61.4%) had junior title or below, 15(18.1%) had medical information or case management as their major, 29(34.9%) coders had not obtained a coding certificate, 31(37.3%) were dissatisfied with the salary system, and 14(16.9%) had a tendency to leave. The medical record coders with lower professional titles, coding certificates and lower salary satisfaction were more likely to have the intention of resignation.Conclusions:Medical record coders in Anyang were challenged with such problems as shortage of manpower, low percentage of coding certificate holders and low salary satisfaction. Title, code certificate issuance and salary satisfaction were correlated with their resignation intention. Hospital managers should strengthen the importance of medical record coding and coders, and establish a reasonable salary, title evaluation and performance incentive system, so as to improve the attractiveness of coder position.
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Objective:To explore the integration path of medical resources in regional medical consortium, find out the problems affecting the process of integration, and put forward relevant suggestions.Methods:Methods According to the purposive sampling and combined with grounded theoretical research methods, semi-structured interviews were conducted with 73 government officials, heads and backbones of medical institutions in different regions of a city from August to November 2019. The data obtained from semi-structured interviews were analyzed by using grounded theory, and the path framework of medical resource integration in regional medical consortium was constructed through open coding, spindle coding and selective coding.Results:Four key links of medical resource integration in the regional medical alliance were sorted out, namely, integration prerequisites, integration strategies, support conditions, and integration methods, which together constituted the main axis of the theoretical framework. In addition, integration methods were affected by integration prerequisites, integration strategies and support conditions. The four factors and integration willingness served as influencing factors to exert impact on the integration tendency.Conclusions:The integration of medical resources in the medical alliance is a systematic project, which emphasizes the organic and overall governance of each key link, and the interaction between various elements will affect the final effect of medical resource integration.
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As an important part of the construction of national emergency management system, emergency material support is the material basis and important guarantee for the smooth implementation of emergency work. In the face of the outbreak and spread of COVID-19, China′s public health emergency management system and emergency management system have achieved certain results in epidemic prevention and control, but also exposed some shortcomings. The authors summarized the management experience and existing problems of China′s emergency medical materials in storage, production, transportation and deployment during the COVID-19 epidemic, and discussed the management path and method of emergency medical materials in peacetime and wartime, which should be jointly built by the government, society, enterprises and the public. The following suggestions are put forward: multi agent participation in expanding the scope and scale of emergency medical supplies reserve, refining and adjusting the inventory and structure of emergency medical supplies reserve; establishing a supply chain list of emergency medical supplies to ensure the " wartime" production capacity; establishing a comprehensive management information platform for medical materials with " peacetime and wartime integration" ; and improving the awareness and ability of community and family′s " peacetime" medical material reserve.
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Objective To calculate the standardized cesarean delivery rate by considering the individual characteristics of puerprae, and to evaluate the medical quality of obstetrics in the hospital. Methods Medical records of 69 406 puerprae from January to December in 2016 were collected from 33 tertiary general hospitals in Shanxi province. A logistic regression model was used to construct a maternal risk adjustment model of cesarean delivery, with the area under the ROC curve (AUC) used to evaluate the goodness of fit of the model. Results Of the 69 406 puerprae, 30 881 used caesarean delivery, accounting to 44. 37% . The cesarean section rate difference was statistically significant among those of different age, nationality, conditions upon admission, whether to participate in a clinical pathway, fetus number, birth weight and maternal gestational age, as well as the severity of complications (P< 0. 001). According to the logistic model, those of older age, history of cesarean delivery, twins or triplet births, neonatal overweight, malposition, placenta previa, and those with various pregnancy complications tend to use maternal cesarean section surgery, with a goodness-of-fit of 0. 82. With risk adjusted, the ranking of actual cesarean section rate and standardized cesarean section rate varies among the hospitals. Conclusions With the factor of puerprae factor adjusted, the standardized cesarean delivery rate can eliminate risk factors of the puerprae, it is feasible to scientifically evaluate the cesarean delivery rate of the hospital′s obstetric department.
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Beginning with an introduction to overseas practices of privilege management, this paper analyzed the current privilege management of medical qualifications in China. On such basis, the authors introduced their insights and specific recommendations for the design and implementation of such management in China. These include: a platform for privilege management, a classified catalogue for medical qualifications, a procedure for the application, approval, examination and dynamic management of the qualifications, and an informatization platform for privilege management.
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Beginning with an introduction to overseas practices of privilege management, this paper analyzed the current privilege management of medical qualifications in China. On such basis, the authors introduced their insights and specific recommendations for the design and implementation of such management in China. These include: a platform for privilege management, a classified catalogue for medical qualifications, a procedure for the application, approval, examination and dynamic management of the qualifications, and an informatization platform for privilege management.
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Objective To analyze the distribution characteristics and risk factors of extended stay over 30 days at tertiary comprehensive hospitals, and explore methods of shortening average length of stay(LOS).Methods Homepage of all inpatients discharged from October 2014 to October 2015 of 31 tertiary comprehensive hospitals in Shanxi province were collected.39 234 cases of these inpatients stayed over 30 days and their case information was complete.A generalized linear model was used for risk factors analysis.Results With the extension of LOS, most of the inpatients with extended stay were found during their 30th-40th days, accounting for 50.21% of all and constituting the highest daily costs as well.The ratio of inpatients decreases with their LOS, and its distribution presents a positive skew in entirety.Distribution of inpatients over 30 days identified urban employees under medical insurance accounting for the highest ratio among all payment categories,and those from the department of orthopedics for the highest ratio among all departments, while those of diseases from injury and poisoning accounting for the highest ratio among all disease categories.The findings indicated ten important factors for extended stay, namely gender, medical payment category, ICD, inter-department transfer, nosocomial infection, and clinical pathway.Conclusions To strengthen management of specific departments and inpatients, focus on key process of medical quality, and accelerate medical insurance payment reform can effectively control extended stay.
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Public hospital reform is the key to medical reform in China, and it is found that there is an obvious effect boundary between the zero margin drug profit and adjustment of medical service price reform, after looking back to progresses in these years.Mainly because it is not reasonable to cut off and change the internal motivation of supplier-induced demand, by the above two polices, It is of great concern to arouse medical staff''s enthusiasm about public hospital reform, by adjusting the remuneration system of the public hospital, which is also the most deep-seated mechanism problem of Public hospital reform.Starting from the overall policy framework of Public hospital reform in Sanming city, this study illuminates the inherent logic and margin of effect between the policies of reform of physicians'' remuneration system.From the analysis, it has been realized that physicians'' compensation system is the logic foundation of deep-rooted institutional problem.The present study draws a conclusion that it is not realistic to make great achievement by one or more policies.Meanwhile, it is rational to reach consensus on key links and progress of reform, by the deep understanding and analysis of public policy integrality.
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Objective To summarize the hot spots and cutting-edges by exploring Multidisciplinary Team (MDT) research in cancer.Methods CiteSpace is used to analyze MDT in cancer visually.Results 2 160 related literatures,10 key literatures,15 main clusters and 29 burst terms are detected.Conclusion MDT research on cancer mainly focuses on operation process,implemention and evaluation of effects.Improving efficiency,cost-effectiveness analysis and randomized controlled trial is the cutting-edge topics.This provides a new perspective for China.
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The research probed into studies at home and abroad on the correlation between hospital service capacity and quality of care,without finding definite correlation between the two.In view of such issue in China,the authors discussed the corelation between hospital service capacity and quality of care of China's hospitals,the relationship between hospital scale expansion and medical quality,and the evaluation of medical quality,providing references for researchers and policy-makers.
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Objective:This study aims to explore recent developments in DEA-based hospital efficiency studies in China, so as to provide reference for further research in DEA-based hospital efficiency. Methods:In this study, a 30-year retrospective systematic review is conducted for the classification of 85 hospital efficiency studies that have been published in China with DEA. The characteristics are summarized and compared with those of international liter-ature according to the selection of input and output indicators to evaluate the normalization of studies in China. Re-sults:The classification reveals several problems existing in DEA-based hospital efficiency studies in China, such as too few studies on hospital allocation efficiency, the application of simple classical models, imprecise selection of in-put-output indicators, inappropriate application of monetary variables as output indicators, etc. Conclusions and sug-gestions:The normalization and rationality of DEA methods applied in China’s hospital efficiency research need to be improved, so as to shorten the gap between China and the international world. Chinese researchers should pay more attention to studying the latest international research findings, so as to scientifically select input and output indicators. In depth analysis of methods and application conditions should be conducted so as to improve the normalization and science of China’s hospital efficiency research.
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In the context of ongoing health reform,it is important to establish and improve the regulation system of public hospitals.By defining the concept of regulation,regulation theories for public hospitals,the regulation systems of the typical countries,the paper summarizes the international experience enlightenment to China's public hospital regulation reform.
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The authors analyzed the status quo of the indicators, outcomes and uses,methodology, procedures and technologies of the variations management of clinical pathways in China the abroad. The outputs of the study point to the following assignments in such a management, such as further identification of the contents of such variations, and further clarification of variation analysis indicators.
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Implementation of clinical pathways has a natural tie with payment modes of medical insurance,as various payment modes apply different impacts on clinical pathway.This article compared the strengths and weaknesses of various payment modes,and analyzed their impacts on clinical pathway.This way the authors provide references for decision makers of medical insurance policy.
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Objective To find out present condition and differences in implementation of clinical pathways in hospitals of in China.Methods "Clinical pathway" was entered as a keyword to search in PubMed NCBI Chinese Science and Technology Periodical Database for related literatures in China from 1999 to 2009,analyzing the general implementations of clinical pathways in hospitals in different areas using the SPSS12.0 software.Results A total of 1051 relevant literatures were found.Through data analysis of these literature,differences of implementation of clinical pathways were found for 162 hospitals of different areas.It was found that the differences of total diseases among China's East,West and Central areas are significant statically.Diseases of implementation per hospital in the Central average 16.8,those in the East 8 types,while those for the West 4.4.Tertiary hospitals account for 70% as the main force of clinical pathway implementation,with diseases of implementation up to 13.7,while that under tertiary level down to 2.8.Conclusions Implementation of clinical pathways varies significantly among hospitals in different areas in China.In the process of implementing clinical pathway,appropriate management strategies should be developed according to actual situation in different hospitals in light of policies,hospital management and patient considerations.