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The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.
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The performance evaluation is an effective method to guide the public hospitals behavior and pro-mote their sustainable development.The introduction of disease severity could make the performance evaluation sys-tem more scientific and reasonable, and encourage the hospitals to improve their technical skills and services ability. Based on the Shanghai diagnosis related groups system, a case-mix index ( CMI) was introduced and a severity score of disease was developed after the relative weight ( RW) adjustment to evaluate different types of disease severity in hospitals.The results have shown that CMI effectively reflects the patients'disease severity and the intensity of treat-ment in those hospitals taken into consideration.Therefore, the scientific indicators should be selected and the evalu-ation system should be improved thereby establishing an effective monitoring and dynamic adjustment mechanism and further developing the diagnosis related group application.
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The severity of disease can be used to evaluate the current situation of patients as well as to predict the diseases outcome.In the meantime, the severity among different diseases has been more and more applied in the evaluation of the patients at hospital level.This study collected and summarized different types of international disea-ses grouping tools'characteristics and applications based on the severity of disease, and their suitability and practical values in hospital performance evaluation were compared and analyzed.
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Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.
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This paper uses the data collected from 138,477 patient discharge records of 37 Shanghai tertiary public hospitals in December 2013 and classifies all the records into different groups by using a localized diagnosis re-lated group tool.The coefficient of variation index ( CV) of each group was used to analyze the dispersion of average hospital cost per inpatient day for each group, in order to evaluate the suitability of diagnosis related group systems and to set the coefficients of difficulty ( relative weights) for each disease.The study has found that severity-based di-agnosis related group systems are more suitable and consistent.However, future studies should collect more detailed information on health costs in order to reflect the value of health professionals and technologies and therefore further improve diagnosis related classification and develop new systems that can be adapted to local conditions by applying the weights of different groups.
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Objective To explore methods for performance appraisal of directors of municipal hospitals in Shanghai.Methods To assess the management performance of directors of 24 tertiary hospitals each year,measured by five dimensions of social satisfaction,management efficiency,capital operation,development sustainability and staff satisfaction,and 23 indexes.Results Implementation of the performance appraisal has witnessed constant improvement of patient satisfaction and quality of medical care,as well as rational control of medical expenses and cost.In 2014 for example,the cost of emergency/outpatients per visit at such hospitals were 312 yuan and 1 5 600 yuan per hospitalization respectively,with 7.6 days of stay in average.Also improved were service efficiency,clinical research output and hospital business performance in general.Conclusion Performance appraisal of directors of public hospitals proves an important means for guiding the hospitals to adhere to public welfare, consistent with the government medical institution operation target, and to strengthen internal management of such hospitals.
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To sum up the reform of internal performance appraisal system and income allocation system of Shanghai municipal hospitals.The internal performance appraisal index system,evaluation methods and corresponding income allocation system,featuring two breaks,one change and eight elements.The reforms highlight public welfare nature of public hospitals,which is expected to create profound impacts on hospital operation and medical staff behavior.
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This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.
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Objective:Needling lumbosacral acupoints could regulate unstable bladder (USB).The present study is to observe the ambulatory urodynamics changing of needling Huiyang (BL 35) on USB to provide scientific basis for the relative theory of acupoint and Zang-fu organs,and the rule of acupuncture treatment.Methods:Unstable bladder model were prepared in 80 Wistar rats,and then they were randomly divided into treatment group (n=40) and model group (n=40).The urodynamics were monitored respectively at 2 h,6 h,12 h and 24 h after acupuncture and the results were analyzed.Results:After acupuncture Huiyang (BL 35),the compliance of bladder were superior to that of model group at 2 h,6 h and 12 h,respectively (P＜0.05),and the bladder volume were superior to that of model group at 2 h and 12 h,respectively (P＜0.05).After acupuncture Huiyang (BL 35),the compliance and Volume of bladder at 12 h were superior to those at other time (P＜0.05).Twenty-four hours later,the effect of acupuncture on urodynamics decreased.Conclusion:Needling Huiyang (BL 35) could improve the urodynamics of USB,including improving the compliance of bladder and increasing the volume of bladder.Acupuncture Huiyang (BL 35) had the most effect at 12 h.
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Objective:To investigate the effects of acupuncture of Shenshu(BL 23),Huiyang (BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)on the main symptoms of unstable bladder (USB)and explore the specificity of different points in treating USB through a clinical randomized controlled trial.Methods:Eighty-nine USB patients were allocated to three groups:Shenshu(BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35).I-PSS was used as an observation index.The effects were evaluated and a comparison was made between the groups after three and six treatments.Resuits:I-PSS significantly improved in all Shenshu (BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups of USB patients (P＜0.05).The effect was significantly beaer in the Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups than in the Shenshu(BL 23)group(P＜0.05).The efficacy rate was 50.0% in the Shenshu(BL 23)group,82.8% in the Huiyang(BL 35)group and 90.0% in the Shenshu(BL 23)plus Huiyang(BL 35)group.It was significantly higher in the Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups than in the Shenshu(BL 23)group(P＜0.05).Conclusion:Points Shenshu(BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)can all regulate voiding dysfunction and improve quality of life in USB patients.Shenshu (BL 23)plus Huiyang(BL 35)has the most marked therapeutic effect.
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OBJECTIVE: To observe the effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. METHODS: Rat models of unstable bladder were established by operation to induce urethral obstruction. Electroacupuncture treatment was given by acupuncturing Huiyang and Zhonglushu points for a week. Then the neuronal nitric oxide synthase (nNOS)-, endothelial nitric oxide synthase (eNOS)- and inducible nitric oxide synthase (iNOS)-positive cells in bladder neck and detrusor of the rats were observed. RESULTS: The nitrergic neurotransmitter in bladder neck and detrusor were obviously decreased in rats with unstable bladder. The electroacupuncture treatment could significantly increase the contains of NOS in bladder tissue. CONCLUSION: To promote the synthesis and secretion of nitrergic neurotransmitter in bladder tissue may be one of the mechanisms of acupuncture in adjusting bladder function.
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<p><b>OBJECTIVE</b>To evaluate objectively clinical effects of different needling methods on urethral syndrome.</p><p><b>METHODS</b>Eighty-nine cases of female urethral syndrome were randomly divided into an electroacupuncture group and a hand-acupuncture group. The scores were evaluated with I-PSS of International Urine-Controlled Association and life quality before and after treatment, and their therapeutic effects were compared.</p><p><b>RESULTS</b>The abnormal symptoms of urination alliviated in the both groups (P < 0.05); the short-term cured rate was 51.8% in the electroacupuncture group, which was higher than 17.1% in the hand-acupuncture group (P < 0.05).</p><p><b>CONCLUSION</b>The therapeutic effect of electroacupuncture on female urethral syndrome is better than that of the hand-acupuncture.</p>