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Objective:To analyze internal composition of hospitalization expense for patients with cerebral infarction. Methods:Data of hospitalization expenses from patients with cerebral infarction discharged from 2014 to 2018 were collected, and analyzed with grey correlation and degree of structural variation. Results:The costs for rehabilitation treatment, medicines and consumables mainly contributed to structural variation, accumulated to 74.63%. The costs for rehabilitation treatment (0.982), medicine (0.979), imaging (0.978) and laboratory tests (0.972) were the most relative to the average expense of hospitalization. Conclusion:It is preliminarily successful for cost control, and needs further impove to respond the contribution of professionals.
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Objective:To investigate the defensive medicine of physicians in the process of rehabilitation. Methods:Defensive medicine were investigated from the medical records of 220 inpatients included in the clinical pathway of stroke rehabilitation from January, 2016 to January, 2018. Results:There might be some defensive medicine behaviours for diagnosis, treatment, prevention of medical tangle, etc., in stroke rehabilitation. Conclusion:It is needed to reduce defensive medicine in various ways.
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Objective:To evaluate the learning outcome of continued education based on Kirkpatrick model for professionals in rehabilitation institutes. Methods:A total of 190 rehabilitation trainees from 2018 to 2019 were investigated with Kirkpatrick model, from the reaction layer, learning layer, behavior layer and results layer, to evaluate the training effect. Results:From reaction layer, the total satisfaction was high from three aspects including general feeling, hospital management and department management. From learning layer, the score of theoretical results significantly improved (t = 32.476, P < 0.001), and the score of practical skill was (81.99±9.59). From behavior layer, their abilities of doctor-patient communication, risk management, writing, rehabilitation evaluation, identifying key points of problems, formulating rehabilitation plans and implementing operations improved (t > 14.364, P < 0.001). From results layer, the complaint rate was 0%, and the accident rate was 0%; three trainees published papers. Conclusion:Kirkpatrick model could evaluate the training comprehensively. Rehabilitation training could improve the quality and ability of trainees.
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Objective:To explore the application value of quality control tools in rehabilitation clinical pathway management. Methods:Quality control tools, such as PDCA circulation, fishbone chart, Gantt chart and 5W1H, were used to analyze the clinical path implements, to find out the reasons for the low rate of clinical pathway entry and completion, and to make continuous improvement. The data from July, 2013 to June, 2018 were divided into ten boxes as half-a-year. The former five boxes were as control group, and the latter five boxes were as study group. Results:There was no significant difference in the number of discharged patients between the study group and the control group (t < 2.260, P > 0.05), but there was significant difference between the two groups in the number of patients entering the rehabilitation, variation and completion in the rehabilitation and the total clinical pathway (t > 6.501, P < 0.001). There were significant differences in the rate of entering total clinical pathway, and the rate of the variation and the completion of total clinical pathway (χ2 > 10.973, P < 0.001). Conclusion:Application of quality control tools can expand the implement of clinical pathway, improve the rate of entry and completion in clinical pathway, and reduce the variation.
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Objective:To explore the application value of quality control tools in rehabilitation clinical pathway management. Methods:Quality control tools, such as PDCA circulation, fishbone chart, Gantt chart and 5W1H, were used to analyze the clinical path implements, to find out the reasons for the low rate of clinical pathway entry and completion, and to make continuous improvement. The data from July, 2013 to June, 2018 were divided into ten boxes as half-a-year. The former five boxes were as control group, and the latter five boxes were as study group. Results:There was no significant difference in the number of discharged patients between the study group and the control group (t < 2.260, P > 0.05), but there was significant difference between the two groups in the number of patients entering the rehabilitation, variation and completion in the rehabilitation and the total clinical pathway (t > 6.501, P < 0.001). There were significant differences in the rate of entering total clinical pathway, and the rate of the variation and the completion of total clinical pathway (χ2 > 10.973, P < 0.001). Conclusion:Application of quality control tools can expand the implement of clinical pathway, improve the rate of entry and completion in clinical pathway, and reduce the variation.
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Objective The invasive colonoscopy is an important method for evaluating the severity of intestine and the muco-sal healing in ulcerative colitis(UC)patients. The aim of this study was to investigate the advantage of fecal calprotectin(FC)in diagnosing UC endoscopic activity and severity and analyze the FC correlation with endoscopic scores. Methods A total of 70 UC in-patients in our hospital from January 2016 to September 2017 were retrospectively analyzed and categorized into endoscopic remission UC [mucosal healing(n=12),mucosal lesion(n=10)]and endoscopic active UC[mild-moderate(n=30)and severe(n=18)]according to UC Endoscopic Index of Severity(UCEIS).The ROC curve was used to analyze the predictive efficacy of each laboratory indicator to identify endoscopically active UC and severe UC and evaluate the correlation of UCEIS with all these indicators. Results In UC pa-tients,the levels of FC[828.5(416.6,1079.7)μg/g],PCT[0.03(0.02,0.06)μg/L]and IL-6[13.4(7.32,21.45)ng/L]were sig-nificantly higher in endoscopically active UC than those[43.4(9.4,91.4)μg/g、0.02(0.02,0.03)μg/L、5.82(5.14,6.73)ng/L]in remission and the levels of CRP,ESR,WBC count and PLT count also increased significantly,while HB and ALB levels were signifi-cantly lower than those in remission(all P value<0.001).In endoscopically active UC patients,the levels of FC[1117.1(916.5,1492. 4)μg/g]and IL-6[18.18(12.72,33.25)ng/L]were significantly higher than those of mild-moderate UC[622.4(218.7,924.2)μg/g,8.27(7.08,16.60)ng/L](P<0.05)and the levels of CRP,ESR and WBC also increased significantly(P<0.05),while the ALB showed a significant lower level(P=0.002). When FC>175.6 μg/g,it was of higher accuracy in diagnosing UC endoscopic activity and the sensitivity,specificity,positive predictive value and negative predictive value were respectively 87.50%,90.91%,95.45%and 76.92%;When FC>781.1 μg/g,it was of higher accuracy in diagnosing severe UC and the sensitivity,specificity,positive predic-tive value and negative predictive value were respectively 88.89%,73.33%,66.66% and 91.66%. The levels of FC,PCT,IL-6, CRP,ESR,WBC and PLT all presented positive correlation with UCEIS(P<0.001),while the HB and ALB levels showed a negative correlation with UCEIS(P<0.001). Conclusion FC is a good indicator to judge UC endoscopic activity and severe UC. FC can be used as a non-invasive and surrogate marker for endoscopy to monitor UC disease activity in clinical practice.
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@# ObjectiveTo analyze the sickbed setup and utilization in the general rehabilitation center and offer gists for strengthening hospital optimize project of sickbed setup.MethodsThe factual sickbed demand, standard sickbed demand and the ratio of confessing and requiring were counted and analyzed.ResultsThe sickbed turnover times of the internal medicine and ICU were accord with request, but the rate of sickbed utilization was higher, the sickbed utilization rate of the other section offices were higher. The sickbed turnover times were lower compared with control lever.ConclusionThe hospital manager should take some measures for optimize sickbed setup, and strengthen manage to improve the medical quality.