Long-term Hospitalization Payment in the US.and Germany and the Enlightenment for Average Cost of Beds Based Payment in China / 中国卫生经济

The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.

Trajectories of glucose and lipid metabolism of schizophrenic patients in long-term hospitalization： a real-world study / 四川精神卫生

ObjectiveTo picture the trajectory of changes in glucose and lipid metabolism among schizophrenic patients in long-term hospitalization. MethodsA total of 109 inpatients of Shenzhen Kangning Hospital from 2014 to 2022， who were diagnosed with schizophrenia based on the International Classification of Diseases， tenth edition （ICD-10） criteria， were recruited as subjects. Real-world follow-up data on longitudinal glucose metabolism （fasting blood glucose， glycosylated hemoglobin， C-peptide） and lipid metabolism （triglycerides， low density lipoprotein， high density lipoprotein， total cholesterol） were observed. The frequency of visit was once a year， with a total of 9 visits over 8 years. ResultsIn terms of glucose metabolism parameters， fasting blood glucose level decreased to 4.87 mmol/L at the 7th visit， lower than the baseline level （P<0.01）. Glycated hemoglobin level was 6.08% at the 9th visit， higher than the baseline level （P<0.05）. C-peptide level was 3.14 ng/mL at the 7th visit， higher than the baseline level （P<0.01）. As for the trajectory of lipid metabolism parameters， high-density lipoprotein level were significantly lower than baseline level at the second visit （P<0.01） and stayed basically stable thereafter. Total cholesterol levels at the last three visits were 4.06， 4.07 and 3.95 mmol/L， respectively， all lower than the baseline level （P<0.01）. ConclusionThe changes of glycolipid metabolism parameters in long-term inpatients with schizophrenia were generally smooth during the 8-year follow-up period.

Application of ACMMM management model in elderly patients with unsafe events / 中国实用护理杂志

Objective@#To explore the application of ACMMM management model in elderly patients with unsafe events.@*Methods@#A retrospective analysis of elderly patients who had been hospitalized for more than three months at the Chinese People′s Liberation Army General Hospital from May 2017 to May 2018 was performed. According to the patient′s hospitalization time, they were divided into group A and group B. Group A was hospitalized between May 2016 and May 2017 (n=1 258), and group B was hospitalized between June 2017 and May 2018 (n=1 309). Patients in group A were given routine nursing intervention, and patients in group B were combined to implement ACMMM management model intervention on the basis of routine nursing intervention. The incidence of various types of unsafe events in the two groups of patients was compared. The severity of the fall in the two groups of patients was compared. Comparison of nursing satisfaction between the two groups of patients.@*Results@#In group A, 47 patients had unsafe events, 11 patients in group B had unsafe events, and group A had higher incidence of unsafe events than group B (χ2=24.358, P<0.05). In group A, the frequency of pressure sores and burns was higher than that of group B (χ2=7.966, 4.353, 5.800, P<0.05). There was no statistically significant difference in the frequency of occurrence of falling, suffocation, self-injury, and misuse between the two groups (P>0.05). The severity of patients with falls in group A was higher than that in group B (Z=-2.124, P<0.05). The satisfaction of nursing in group B was 79.53%(1 041/1 309), the satisfaction of nursing in group A was 57.15%(719/1 258), and the satisfaction degree in group B was better than that in group A. The data were statistically significant (Z=-15.238, χ2=148.962, P <0.05).@*Conclusions@#The use of ACMMM management model for long-term hospitalized elderly patients with nursing intervention can effectively reduce the incidence of unsafe events in elderly patients, reduce the severity of falls and other related injuries, and effectively improve patient care satisfaction.

Application of ACMMM management model in elderly patients with unsafe events / 中国实用护理杂志

Objective To explore the application of ACMMM management model in elderly patients with unsafe events. Methods A retrospective analysis of elderly patients who had been hospitalized for more than three months at the Chinese People′s Liberation Army General Hospital from May 2017 to May 2018 was performed. According to the patient′s hospitalization time, they were divided into group A and group B. Group A was hospitalized between May 2016 and May 2017 (n=1 258), and group B was hospitalized between June 2017 and May 2018 (n=1 309). Patients in group A were given routine nursing intervention, and patients in group B were combined to implement ACMMM management model intervention on the basis of routine nursing intervention. The incidence of various types of unsafe events in the two groups of patients was compared. The severity of the fall in the two groups of patients was compared. Comparison of nursing satisfaction between the two groups of patients. Results In group A, 47 patients had unsafe events, 11 patients in group B had unsafe events, and group A had higher incidence of unsafe events than group B (χ2=24.358, P<0.05). In group A, the frequency of pressure sores and burns was higher than that of group B (χ2=7.966, 4.353, 5.800, P<0.05). There was no statistically significant difference in the frequency of occurrence of falling, suffocation, self-injury, and misuse between the two groups (P>0.05). The severity of patients with falls in group A was higher than that in group B (Z=-2.124, P<0.05). The satisfaction of nursing in group B was 79.53% (1 041/1 309), the satisfaction of nursing in group A was 57.15%(719/1 258), and the satisfaction degree in group B was better than that in group A. The data were statistically significant (Z=-15.238, χ2=148.962, P <0.05). Conclusions The use of ACMMM management model for long-term hospitalized elderly patients with nursing intervention can effectively reduce the incidence of unsafe events in elderly patients, reduce the severity of falls and other related injuries, and effectively improve patient care satisfaction.

Research on the effects of adequate vegetables and fruits on the improvement of senile pruritus of elderly people in hospital / 中国实用护理杂志

Objective The purpose of this study is to help long term in-patients with senile pruritus choose the appropriate die and further relieve pruritus and improve the quality of life. Methods Totally 37 cases of elderly people with senile pruritus were selected as the observation group who were in community health service center from June 2015 to February 2016. The control group was selected from a welfare hospital. Both of the two groups were evaluated by the degree and the area of pruritus. The control group followed the original diet. The observation group was given enough fruits and vegetables. After six months intervention, the evaluation of the degree and area of pruritus, the rate of skin infections etc were constructed. Results After 6-month intervention, the cases of severe pruritus, skin infection, mini nutritional assessment no less than 24, the constipation, and patients without depression by the Depression Rating Scale in the observation group were 10.81%(4/37), 5.41%(2/37), 64.86%(24/37), 13.51%(5/37), 89.19%(33/37). The cases of the control group were 67.57%(25/37), 43.24%(16/37), 24.32%(9/37), 91.89%(34/37), 43.24%(16/37). According to the two groups, the differences were statistically significant (χ2=12.31-45.59;P<0.05 or 0.01) . The percentage of skin itching area in the observation group was 13.00%(0, 32.25%), the differences were statistically significant from that in the control group, 32.00%(22.00%, 50.50%) (Z=29.53, P<0.01). Conclusions Ensuring enough intake of fruits and vegetables can reduce the morbidity of senile pruritus in long-term in-patients and further improve the quality of life.

A Study of the Current State of the Mental Health Service Delivery System Using the Focused-Group Interview / 신경정신의학

OBJECTIVES: To use focus-group interviews (FGI) to determine the current state of the Korean mental health service delivery system, inter-agency patient links, and identify associated problems. METHODS: The FGI were conducted by seven workers from psychiatric rehabilitation centers and community mental health centers and seven social workers from mental health hospitals. RESULTS: Within the mental health service delivery system, disconnection of the community network after discharge is considered a serious problem. The following improvement proposals are suggested : 1) the control tower should govern the community network after discharge, 2) consider insurance costs during activation of hospital links, and 3) expand information sharing related to community social facilities. With regard to non-voluntary admission and long-term hospitalization, most focus group members considered the revolving-door phenomenon to be more serious than non-voluntary admission. In order to prevent unnecessary long-term hospitalization, the FGI results indicated that the government should proactively intervene in the admission/discharge process. In addition, the following improvement proposals were suggested : 1) functional activation of the mental health review board via the reinforcement of workers' expertise, 2) expansion of local mental health centers, and 3) undertake institutional changes related to the family-related issue of preferring hospitalization over a stay at a secure facility. CONCLUSION: For the government to improve the efficiency of the mental health service delivery system, it is necessary to improve institutional linkages, expand mental health infrastructure, and develop an integrated management system.

A Study on Factors Related to Long-term Hospitalization in Patients with Chronic Schizophrenia / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate the factors related to long-term hospitalization of schizophrenia. METHODS: The subjects were inpatients with schizophrenia who were constantly hospitalized for more than 12 months and their caregivers. They were compared with schizophrenia with no previous experience of sustained hospitalization for more than 12 months and their caregivers. Demographic and clinical data, Korea version of the Positive and Negative Symptom Scale, functional disability and family burden scale were analyzed. RESULTS: In this study long-term hospitalization of schizophrenia was influenced by the following measures. First, primary caregivers variables such as parents/non-parents and cohabitation with patients, second, negative symptom severity of passive/apathetic social withdrawal and lack of spontaneity and flow of conversation, and third, functional disability of go to hospital/take a dose regularly and using public transportation/facilities were associated with long-term hospitalization. And they were significant in logistic regression analysis. CONCLUSION: The above results suggest that long-term hospitalization of schizophrenic patients in Korea might be affected by caregiver's factor, negative symptoms, and functional disability.

Ethical Thinking on Long-term Stay Emergency ICU Patients / 中国医学伦理学

In this paper , the causes of patients in emergency ICU were analyzed .The authors used classical theory of ethics to illuminate and put forward the ethical principles that both doctors and patients should follow and the conception of patients′moderate right , as well as the relevant suggestions and strategies , with the aim to make the application of emergency ICU medical resources more reasonable and make the treatment and cure of the emer -gency and critical patients more conform to the requirement of the ethics .

Comparison between Users of Community Mental Health Services and Psychiatric Patients in Mental Health Related Facilities in Korea / 대한정신분열병학회지

OBJECTIVES: This study was conducted to compare the characteristics of psychiatric inpatients in mental health related facilities and community mental health services-utilizing patients by diverse factors in Korea. METHODS: Questionnaires were sent via mail to 140 standard mental health centers from October to December of 2008. 64 facilities responded and data of 461 mentally disabled who are registered at and utilize the services of these mental health centers were analyzed. T-test and cross-analysis were performed to determine the differences in the averages of the variables and the discrepancy in ratios, respectively. RESULTS: Differences between long-term psychiatric inpatients and community mental health services-utilizing patients were seen in characteristics such as gender, age, type of medical coverage, family support systems, diagnosis, age of onset, duration of hospitalization, community-dwelling period, and clinical symptoms and functions. It was significantly short in length of stay in facilities in users of community mental health services with comparison to institutionalized patients. CONCLUSION: The results of this study suggest that invigoration of community mental health services is an alternative that can help deter long-term hospitalization.

The Disagreement of Discourse and Power Through the Experiences of Nursing for Caring of Long-term Hospitalized Patients / 성인간호학회지

PURPOSE: This critical ethnography was performed to explore the experiences of nurses who are working with patients in an industrial disaster hospital. During the research process, I focused on the experiences of conflict in caring patients. METHODS: Data for the study came from 13 informants with their corresponding patients through interview and observation from March 2002 to February 2004. The data was examined line by line; then compared and contrasted based on a critical discourse analysis. RESULTS: Nurses' conflicts came from discrepancies of the world views from that of the patients. Such conflicts arose because of various issues as follows: Worker as an individual vs patients, nurse as young women vs the medical profession, hospital as an extended home vs health care setting, and hospitalization as a means to enhance work capacity vs a means of treatment. CONCLUSION: We need more study on the development of adaptive strategy for the nurses to overcome conflicts during their nursing career. Developing a nurses' and patient role intervention program is needed.

A Survey on the Long-term Hospitalized, Chronically Mentally-ill Patients in Mental Health Facilities / 신경정신의학

OBJECTIVES: In an attempt to identify the demographic characteristics and the factors influencing long-term hospitalization of chronically mentally-ill patients, a survey on the chronically mentally-ill patients who had been staying longer than 1 year in mental health facilities was conducted. METHODS: Checklist including some demographic data that were regarded as independent variables was applied to 3,477 subjects through administration system of Pusan Metropolitan City. Statistical analyse were done using distribution-free, non-parametric tests. RESULTS: 1)Subjects who had been staying longer than 1 year were 70.7% of the total inpatients of mental health facilities, and median duration of their hospitalization was 5.5 years. 2)In mental hospitals and asylums, the ratio of chronically mentally-ill subjects to the total inpatients in each facilitiy was 46.3% and 95.1%, respectively. 3)All of the 10 independent variables had an influence on the hospitalization duration. CONCLUSIONS: These results indicated that many indirect, extramedical factors had an influence the long-term hospitalization of chronically mentally-ill patients, and it is likely to reflect the underdevelopment of mental health services in Korea.