Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes / 대한뇌졸중학회지

Background@#and Purpose The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems. @*Methods@#We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined. @*Results@#During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (Ptrend <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (Ptrend <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (Ptrend=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications. @*Conclusions@#These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.

Applications of health technology assessment in value-based management of total health expenditure / 中华医院管理杂志

Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′ participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.

Applications of health technology assessment in value-based management of total health expenditure / 中华医院管理杂志

Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.

Patient questionnaire compilation for the public benefit nature of medical institutions as seen by patients / 中华医院管理杂志

Objective An attempt to develop a patient survey questionnaire on the public benefit nature of medical institutions as seen by patients,along with an evaluation of its reliability and validity.Methods A field survey was conducted among the patients visiting these institutions.The Cronbach's α coefficient was calculated to test the reliability.Factor analysis and spearman correlation analysis were applied to test the validity.The validity was also tested by analyzing the demographic factors and comparing the results between different kinds of medical institutions.Results The Cronbach's α coefficient of the questionnaire was 0.853,meanwhile the Cronbach's α coefficient of the three items was 0.845(quality of care),0.845 (suitability of services) and 0.752 (professional ethics).Three common factors were extracted,which coincided with the three items-quality of care,suitability of services and professional ethics.And the results are hardly affected by common demographic characteristics.Condusion The reliability of the questionnaire was acceptable,and the items were reasonably divided in the questionnaire with good structural validity.The questionnaire can be widely applied to evaluate the public benefit nature of medical institutions.