RESUMO
Aiming at the problems of resource allocation, cost control, homogenization management of medical and nursing quality and so on in a hospital with multi-campuses, People′s Hospital of Ningxia Hui Autonomous Region explored an integrated governance system. It incorporated a series of aspects, such as the establishment of Internet hospital platform using payment and settlement as the link, the construction of operation and management mode for integrating information of multiple branches, the completion of " one hospital, multiple branches" organizational structure and integrated operation system, the innovation of personnel and post compensation system in line with features of medical industry, the implementation of new service mode of diagnosis teams and inpatient wards, the execution of budget management and cost accounting control, and the establishment of integrated online and offline epidemic prevention and control system for the joint prevention and control. These practices achieved good effects that quality and efficiency of medical services were greatly improved, cost of medical services was effectively controlled, and the efficiency of hospital operation and management were enhanced. It provided valuable experience for the integrated management of public hospitals with multi-campuses.
RESUMO
Objective:To investigate the influencing factors of hospitalization expenses in high-rate cases, and provide scientific basis for targeted cost control.Methods:The first page data of 79 929 discharged medical records of a tertiary hospital in Ningxia Hui Autonomous Region in 2018 were selected for DRG analysis and evaluation. The average total hospitalization expenses of the same DRG group in the same level and similar hospitals in Ningxia were taken as the benchmark cost to calculate the benchmarking ratio of each DRG group. GM grey correlation method was applied to analyze the correlation between each sub-item cost and the total hospitalization cost of each DRG group, and the logistic regression was used to analyze the influencing factors of high-rate cases.Results:There were 1 292 high-rate cases, accounting for 1.64% of 78 789 DRG-incorporated cases. The results of grey correlation analysis showed that among the 10 high-rate DRG groups, the correlation order of drug cost in 6 DRG groups was the first, and that of consumables cost was the first in 2 DRG groups; logistic regression results showed that age group( P=0.010), actual hospital stay( P<0.001), and mode of leaving hospital( P<0.001) were the influencing factors of high-rate cases. Conclusions:Drug costs, consumables costs, and length of stay have great influence on the hospitalization costs for high-rate cases, which should be paid particular attention to.
RESUMO
Objective@#In order to evaluate the therapeutic effects and safety of denosumab and bisphosphonates in glucocorticoid induced osteoporosis patients.@*Methods@#Standard studies were obtained by searching CNKI, CBM, VIP, Wanfang, Pubmed, Embase and Cochrane databases.@*Results@#Three RCTs with 869 patients were included in this study. It showed that the mean changes of lumbar spine, total hip and femoral neck bone mineral density (BMD) for patients in denosumab group were increased by 2.47%, 1.43% and 1.07% respectively compared to those of bisphosphonates group.There was no statistically significant difference between patients receiving denosumab and those receiving bisphosphonate in terms of adverse events and serious adverse events.@*Conclusions@#Denosumab has an effective increase for lumbar spine, total hip and femoral neck bone mineral density, and the safety of both is similar.
RESUMO
Objective In order to evaluate the therapeutic effects and safety of denosumab and bisphosphonates in glucocorticoid induced osteoporosis patients. Methods Standard studies were obtained by searching CNKI, CBM, VIP, Wanfang, Pubmed, Embase and Cochrane databases. Results Three RCTs with 869 patients were included in this study. It showed that the mean changes of lumbar spine, total hip and femoral neck bone mineral density (BMD) for patients in denosumab group were increased by 2.47%, 1.43% and 1.07% respectively compared to those of bisphosphonates group.There was no statistically significant difference between patients receiving denosumab and those receiving bisphosphonate in terms of adverse events and serious adverse events. Conclusions Denosumab has an effective increase for lumbar spine, total hip and femoral neck bone mineral density, and the safety of both is similar.
RESUMO
Objective To investigate the clinical features and related risk factors of osteoporosis and osteoporotic fracture (OPF) in patients with rheumatic diseases (RD),and the fracture predictive values of fracture risk assessment tool fracture risk assessment (FRAX(R))for Han patients.Methods A total of 313 untreated RD patients were included.Each individual BMD was measured at lumbar spine and femoral neck with Dual-energy X-ray absorptionary.Ten-year probability of fracture (％) was calculated by fracture risk assessment tool FRAX(R) of Chinese model.Each individual previous fracture was confirmed by X-ray or CT examination.The associations between BMD,FRAX),previous fracture and age,bone mass index,nationality,erythrocyte sedimentation rate (ESR) and RD types were analyzed.T test or Wilcoxon test was used to compare the difference between groups for statistical analysis.Pearson/Spearman rank order and binary regression were used to analyze the correlations between variables of normal/non-normal and two classification distribution.Results ① The BMD of patients with untreated RD was significantly lower than that of control group (P=0.000).Individuals diagnosed with "osteopenia" in the RD group and control group were accounted for 39.3％ (123/313) and 15.8％ (47/296) respectively.Individuals diagnosed with "osteoporosis" in RD group and control group were accounted for 11.5％ (36/313) and 5.4％ (16/296) respectively.② The next 10-year probability of the hip (Z=-2.28,P=0.02) and major osteoporotic fracture (Z=-1.98,P=0.03) were higher than those of the control group,as well as the actual incidence of OPF (x2=25.11,P=0.00),the difference was statistically significant.③ 27.3％(18/66) and 55.0％(11/20) of the previous OPF patients in RD group and control group achieved the diagnostic criteria of "high risk" of hip fracture.And 12.1％ (8/66) and 35.0％ (7/20) achieved the "high risk" of major osteoporotic fracture.④ Patients with RA,SLE and pSS had significantly increased risk of fracture.Ten-year fracture risks were negatively related to advanced age,female gender and ESR.Conclusion Bone loss and increased fracture risk are prevalent in the early stage of untreated rheumatism patients.RA,SLE plays an important role in low bone mass.The FRAX China model may underestimate 10-year fracture probability of RD patients and controls.Further explore should be done to predict the FRAX China model on different areas and different RDs.
RESUMO
Objective To propose a remote printing mode for hospital clinical report to enhance the efficiency of clinical staffs.Methods A function module for report export was developed based on scheme demonstration,and the obstacles between internal and external networks were eliminated.Results The mode had the clinical requirements satisfied,medical errors avoided and medical cost saved.Conclusion The mode can be implemented in some hospital with multi sections and ununified information systems,and thus has practical values.