Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services.</p><p><b>METHODS</b>This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination.</p><p><b>RESULTS</b>We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups.</p><p><b>CONCLUSIONS</b>We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.</p>

Comparative Study of Three Commonly Used Methods for Hospital Efficiency Analysis in Beijing Tertiary Public Hospitals, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tertiary hospitals serve as the medical service center within the region and play an important role in the medical and health service system. They are also the key targets of public hospital reform in the new era in China. Through the reform of health system, the public hospital efficiency has changed remarkably. Therefore, this study aimed to provide some advice for efficiency assessment of public hospitals in China by comparing and analyzing the consistency of results obtained by three commonly used methods for examining hospital efficiency, that is, ratio analysis (RA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA).</p><p><b>METHODS</b>The theoretical basis, operational processes, and the application status of RA, SFA, and DEA were learned through literature analysis. Then, the empirical analysis was conducted based on measured data from 51 tertiary public hospitals in Beijing from 2009 to 2011.</p><p><b>RESULTS</b>The average values of hospital efficiency calculated by SFA with index screening and principal component analysis (PCA) results and those calculated by DEA with index screening results were relatively stable. The efficiency of specialized hospitals was higher than that of general hospitals and that of traditional Chinese medicine hospitals. The results obtained by SFA with index screening results and the results obtained by SFA with PCA results showed a relatively high correlation (r-value in 2009, 2010, and 2011 were 0.869, 0.753, and 0.842, respectively, P < 0.01). The correlation between results obtained by DEA with index screening results and PCA results and results obtained by other methods showed statistical significance, but the correlation between results obtained by DEA with index screening results and PCA results was lower than that between results obtained by SFA with index screening results and PCA results.</p><p><b>CONCLUSIONS</b>RA is not suitable for multi-index evaluation of hospital efficiency. In the given conditions, SFA is a stable efficiency analysis method. In the evaluation of hospital efficiency, DEA combined with PCA should be adopted with caution due to its poor stability.</p>

Effect of nerve growth factor-gelatin sponge composite on peri-implant osseointegration / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the peri-implant osseointegration after the application of exogenous nerve growth factor (NGF)-gelatin sponge (GS) composite.</p><p><b>METHODS</b>Six beagle dogs were used to establish bi-mandible simultaneous implant model after the first and second premolar extraction. Then the dental implants were implanted into the distal socket while the bone defect was made in the mesial socket of each mandible. Then the NGF-GS was implanted into the defects as NGF-GS group, the gelatin sponge alone was implanted as GS control and the control group was left empty. Two dogs were sacrificed each time at 4 weeks, 8 weeks and 12 weeks postoperatively. Specimens were subjected to general observation, radiography, bone histological and histomorphometric analysis for the new bone formation. The data were analyzed with SPSS 11.5 software package.</p><p><b>RESULTS</b>The bone density in the defects around implants at 4 and 8 weeks postoperatively was lower than the normal bone. The bone-implant contact ratio in the NGF-GS group [(57.7 ± 6.4)%] was significantly higher than that in the GS control group and the control group [the ratio were (44.2 ± 3.3)% and (31.2 ± 3.1)%] (P < 0.01) at 4 weeks postoperatively, the bone-implant contact ratio in the GS control group was also significantly higher than that in the control group (P < 0.01) at that time. The bone-implant contact ratio in the NGF-GS group [(94.8 ± 7.7)%] was slightly higher than that in the GS control group and the control group [the ratio were (83.0 ± 4.1)% and (86.4 ± 6.3)%] at 8 weeks postoperatively, but there was no statistical difference (P > 0.05). The bone density in the defects around implants at 12 weeks was almost the same as the normal bone, there was no difference of the bone-implant contact ratio.</p><p><b>CONCLUSIONS</b>NGF-GS application could increase new bone formation, accelerate maturation of trabecular bone around the implants and shorten the period of osseointegration.</p>