Application of diagnosis-related groups performance evaluation in fine management of medical quality / 预防医学

Abstract@#Diagnosis-related groups (DRGs), designed to reflect the complexity of grouped cases and the consumption of medical resources, has been utilized for evaluating hospital specialty capabilities and assessing performance. A provincial tertiary hospital in Zhejiang Province has developed a management model based on DRGs performance evaluation with strengthening the medical record quality control, optimizing disease admission structures, and refining data analysis. This article introduced the application of DRGs performance evaluation in this hospital, and proposed suggestions for improvement, including leveraging artificial intelligence and big data and integrating clinical pathway management to further enhance medical care quality. These insights provided the reference for high quality development of hospitals.

Correlation between neutrophil-to-lymphocyte ratio and disease activity in Behcet's disease / 天津医药

Objective To explore the correlation between neutrophil-to-lymphocyte ratio(NLR)and Behcet's disease(BD)activity.Methods A total of 103 BD patients were divided into the low activity group(0-4,61 cases)and the high activity group(5-11,42 cases)according to electronic medical record-based disease activity index(EMRAI)score.The white blood cell(WBC),neutrophil(NEU),lymphocyte(LY),platelet(PLT),red blood cell(RBC),hemoglobin(Hb),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),IgG,IgA,IgM,complement C3 and C4 were detected.NLR and platelet-to-lymphocyte ratio(PLR)were calculated.The correlation between NLR,PLR and ESR,CRP,EMRAI were analyzed.Logistic regression was used to analyze the influencing factors of BD disease activity.Receiver operating characteristic(ROC)curve was drawn to evaluate the effectiveness of NLR in judging BD disease activity.Results WBC,NEU,PLT,ESR,CRP,NLR,PLR,complement C3 and C4 in patients were higher in the high activity group than those in the low activity group(P＜0.05),and there were no significant differences in other indexes(P＞0.05).NLR was positively correlated with ESR,CRP and EMRAI in the whole group,while PLR was positively correlated with ESR,CRP and EMRAI in the whole group(P＜0.05).Logistic regression analysis showed that high NLR was a risk factor for BD disease activity(OR=1.511,95%CI:1.080-2.113,P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR in evaluating BD disease activity was 0.706(95%CI:0.603-0.809).Conclusion NLR is effective in judging the disease activity of BD patients,and can be used as a biological index to evaluate the disease activity of BD.

Construction of a Quality Control System for Oncology Medical Records Based on Natural Language Processing / 医学信息学杂志

Purpose/Significance Through the establishment of a quality control system for electronic medical record(EMR)con-tent,the standardization and normalization of medical record writing is realized,and the quality of hospital medical record is improved.Method/Process The intelligent medical data center is built based on hospital medical data,and the knowledge base and rule base with tumor specialty characteristics are formed by combining natural language processing(NLP)and machine learning technology.The new quality control mode of"pre-audit,comprehensive coverage,process supervision and closed-loop management"of EMR is realized.Result/Conclusion After the application of the medical record quality control system based on NLP,the quality control coverage rate in-creased from 1%to 100%,and the rate of class A medical records increased to more than 96%,with good real-time and accuracy,providing a solid information foundation for the high-quality development of hospital medical records.

To establish a quantifiable evaluation system in improving blood transfusion medical records based on PDCA / 中国输血杂志

【Objective】 To explore the feasibility of establishing quantifiable evaluation system combined with PDCA in improving blood transfusion medical record. 【Methods】 A working group was set up in our hospital to establish an evaluation system for blood transfusion medical record according to relevant norms and literature. The data from September 2022 to February 2023 were used as the control group, and data from from April to May 2023 as the study group. PDCA was used to analyze the causes for poor quality of medical record. The quality of medical record was continuous improved for two months and the results were analyzed. 【Results】 Comparison between the research group and the control group showed that the score of blood transfusion consent (item A), blood transfusion application (item B), blood transfusion evaluation (item C), blood transfusion serious hazard (item F) increased respectively as 17.50±5.54 vs 21.08±3.75 (P<0.01), 16.22±2.05 vs 17.33±1.85 (P<0.01), 13.05±3.5 vs 14.72±1.97 (P<0.01), 7.9±1.44 vs 8.7±0.92 (P<0.01), and the total score of medical record was 85.36±7.5 vs 93.05±5.04 (P<0.01). The qualified rate of medical record increased from 82.2% to 98.3%(P<0.01). 【Conclusion】 The establishment of quantifiable blood transfusion medical record evaluation system combined with PDCA can help realize timely regulation and standardization of blood transfusion medical record.

The Malignancy Medical Record Quality Analysis by Medical Insurance Settlement List / 中国医院管理

Objective To protect the economic benefits of the hospital by improving the medical record quality,quality control ability,and standardising the filling of the medical insurance settlement list.Methods Re-quality control of previous malignant tumour cases,with the help of the intelligent health insurance case collaboration system,compare the changes in case entry and benchmark costs after the revision of errors,analyse the results caused by different errors,and summarise the correct experience.Results Erroneous disease diagnoses can lead to losses or suspected fraud in health insurance billing,affecting the economic operation of healthcare organisations.Conclusion The improvement of the quality of the medical insurance settlement list not only needs to improve the quality of case writing,coding level,but also needs to read the connotation of the policy through extensive study.

Analysis on TCM Syndrome and Treatment Rule of Chronic Atrophic Gastritis Based on Data Mining / 中国中医药信息杂志

Objective To analyze the TCM syndrome and treatment rule for the treatment of chronic atrophic gastritis based on data mining;To provide reference for its clinical treatment.Methods With the help of the big data platform of evidence-based literature of TCM covering several dominant diseases in the field of digestion,literature on the experience of famous doctors,theoretical discussion and case reports in the treatment of chronic atrophic gastritis published from 1 January 2000 to 31 July 2022 was retrieved.Medical records were screened according to the inclusion and exclusion criteria.The data of TCM disease names,clinical symptoms,tongue manifestation,pulse manifestation,TCM syndrome,TCM treatment method and other terms in medical records were standardized and statistically analyzed.Results Totally 169 articles were included,including 228 medical cases,involving 228 patients,with a cumulative number of 361 visits,with an average age of(53.17±11.11)years old,with the largest number of 50-60 years old.Chronic atrophic gastritis mostly belonged to the categories of"stomach pain"and"epigastric puffiness"in TCM,and its main symptoms were stomach pain,epigastric puffiness and belching.The common tongue manifestation include dark red tongue,white moss,thin or greasy moss.The common pulse manifestation included wiry slippery pulse,wiry thready pulse and wiry pulse.The high-frequency syndromes included liver-stomach qi stagnation syndrome,spleen-stomach dampness-heat syndrome,liver-qi stagnation and spleen-qi deficiency syndrome.The disease locations were mainly in the stomach,spleen and liver,and the syndrome elements were mainly qi deficiency,qi stagnation,blood stasis,dampness and heat,etc.The complex syndrome elements were more than the single syndrome elements,and the two syndrome elements of qi deficiency + qi stagnation was the most common.The most commonly used treatment methods were supplementing,regulating qi and regulating blood.Conclusion The treatment of chronic atrophic gastritis with TCM mostly focuses on the stomach,spleen and liver.The core syndrome elements are qi deficiency,qi stagnation,and blood stasis.The methods of nourishing qi and strengthening the spleen,soothing the liver and stomach,regulating qi and blood are often used.

Study on the medication law of treatment for acute mastitis in Pu Ji Fang based on the ancient and modern medical record cloud platform / 国际中医中药杂志

Objective:To analyze the medication characteristics and the rules of prescription for the treatment of acute mastitis in Puji Fang; To provide reference for the clinical treatment of acute mastitis in modern TCM. Methods:Prescriptions of the chapters of " Ruyong" and " Duru" contained in Pu Ji Fang? Fu Ren Zhu Ji Men were screened, and the prescription data were analyzed by using the ancient and modern medical record cloud platform V2.3.5 for drug frequency, properties, tastes, meridian tropism, and efficacy. Clustering analysis of high-frequency drugs and analysis of association rules were performed. Results:A total of 141 prescriptions were included, with 201 kinds of Chinese materia medica. The top ten drugs with the high frequency of use were Glycyrrhizae Radix et Rhizoma, Paeoniae Radix alba, Rhei Radix et Rhizoma, Angelicae Sinensis Radix, Astragali Radix, Olibanum, Trichosanthis Fructus, Ginseng Radix et Rhizoma, Scutellariae Radix, Gleditsiae Spina. The main property was cold, the main taste was sweet, the main meridian was spleen meridian, and the main efficacy was heat clearing and detoxification. Three types of high-frequency drugs could be obtained by clustering analysis, namely, Ginseng Radix et Rhizoma-Astragali Radix-Angelicae Sinensis Radix-Rhei Radix et Rhizoma, Scutellariae Radix-Paeoniae Radix alba-Glycyrrhizae Radix et Rhizoma, Trichosanthis Fructus-Olibanum-Gleditsiae Spina. Through correlation analysis of high-frequency drugs, it was found that there was a great correlation between Astragali Radix and Paeoniae Radix alba, Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizoma, Ginseng Radix et Rhizoma.Conclusions:The pathogenesis of acute mastitis in Pu Ji Fang is mainly damp-heat toxin and blood stasis, and deficiency of qi and blood. The treatment for strengthening healthy qi focuses on tonifying qi and blood of the liver and spleen, while the treatment for eliminating pathogenic factors focuses on removing dampness, clearing heat and toxin, resolving phlegm, dispersing stasis and removing blood stasis. In addition, according to the condition, the treatment will be increased or decreased with the disease.

Hybrid electronic record: An error reduction strategy for diverse medical prescription formats

Background: This project is part of a broader effort to develop a new electronic registry for ophthalmology in the KwaZulu-Natal (KZN) province in South Africa. The registry should include a clinical decision support system that reduces the potential for human error and should be applicable for our diversity of hospitals, whether electronic health record (EHR) or paper-based. Methods: Post-operative prescriptions of consecutive cataract surgery discharges were included for 2019 and 2020. Comparisons were facilitated by the four chosen state hospitals in KZN each having a different system for prescribing medications: Electronic, tick sheet, ink stamp and handwritten health records. Error types were compared to hospital systems to identify easily-correctable errors. Potential error remedies were sought by a four-step process. Results: There were 1307 individual errors in 1661 prescriptions, categorised into 20 error types. Increasing levels of technology did not decrease error rates but did decrease the variety of error types. High technology scripts had the most errors but when easily correctable errors were removed, EHRs had the lowest error rates and handwritten the highest. Conclusion: Increasing technology, by itself, does not seem to reduce prescription error. Technology does, however, seem to decrease the variability of potential error types, which make many of the errors simpler to correct. Contribution: Regular audits are an effective tool to greatly reduce prescription errors, and the higher the technology level, the more effective these audit interventions become. This advantage can be transferred to paper-based notes by utilising a hybrid electronic registry to print the formal medical record.

An observational study of role of medical record department in tertiary care teaching hospital

Background: Medical record document explains all the details about the patient’s history, clinical findings, diagnostic test results, pre- and post-operative care, patient’s progress, and medication given. If written correctly, notes will support the doctor about the correctness of treatment. Aim and Objectives: Our objective was to study effectiveness and utility of medical record department at our medical college affiliated tertiary care institution. Materials and Methods: We did an observational study to determine various parameters of medical records such as consent, history and examination findings, pre-operative and intraoperative records, investigation documentation, nursing care chart, and concerned medical person’s signature. The study included 300 files. A medical record checklist was used as a tool for data collection. The study was conducted between January 2021 and January 2022. Data were collected, entered in Microsoft Excel spread sheet, and analyzed using percentage. Results: Out of the 300 files, 186 files belonged to different surgical specialties while the rest were of non-surgical fields. It was found that nursing assessment document was present in 78%, while discharged card copy was found attached in 75.33% files. Furthermore, surgical safety checklist was found in 89.24%, while signature of faculty was absent in 38.3% files. Conclusion: Medical record maintaining and keeping is an essential and vital part of health-care infrastructure, not only for data collection but also for calculating use of resources needed for better delivery of quality services to patients.

Design and implementation of blood transfusion management system based on electronic medical record application and grading / 现代医院

Objective To address the issues of decentralized blood transfusion services and the persistence of paper-based approval processes,as well as to meet the requirements of electronic medical record grading and interoperability assess-ments.Methods Combining the requirements of the assessments,we have restructured and designed the blood transfusion serv-ice processes,and developed a comprehensive closed-loop management system for clinical blood transfusion based on an integrat-ed platform.Results Six major closed-loop processes were established for blood transfusion services and blood management.This transformation led to more standardized transfusion documentation,centralized blood transfusion services,and enabled data sharing across the entire hospital.Conclusion The rationality,standardization,and safety of clinical blood transfusions have improved,leading to a reduction in the incidence of adverse transfusion reactions.

Establishment and application of drug use evaluation criteria for aminocaproic acid injection / 药物流行病学杂志

Objective To establish drug use evaluation(DUE)criteria for aminocaproic acid injection,and to evaluate and analyse clinical use of aminocaproic acid injection.Methods Based on the aminocaproic acid injection drug label,DUE of aminocaproic acid injection from three aspects(indications,medications and medication results)were established with reference to relevant literature.A retrospective survey was conducted to evaluate the rationality of medication for inpatients who used aminocaproic acid injection from July 1,2021 to June 30,2022 in Fuding Hospital of Fujian University of Traditional Chinese Medicine.Results A total of 143 midical records were included.73 cases fully met the DUE criteria,70 cases did not fully meet the DUE criteria,and the unreasonable rate was 48.95%.The most common types of irrational using of aminocaproic acid injection were inappropriate timing of perioperative prevention of medication(26.57%),overcourse in perioperative prevention of medication(23.08%),and contraindications(7.69%).Conclusions The aminocaproic acid injection DUE standard established is scientific,practical,the irrational rate of aminocaproic acid injection use is relatively high in this hospital,and the management of rational use of aminocaproic acid injection needs to be strengthened.

Study on the Connotation Quality Prediction Model of Inpatient Medical Record Based on Multi-layer Perceptron Neural Network / 医学信息学杂志

Purpose/Significance To explore the important factors affecting the connotation quality of inpatient medical records,and to provide model prediction and improve the connotation quality of inpatient medical records.Method/Process A total of 590 inpatient medical records monitored by quality control in Shanghai First People's Hospital from June to November 2022 are collected.The influen-cing factors are initially screened by single factor analysis,and a multi-layer perceptron neural network prediction model for the connota-tion quality of inpatient medical records is constructed.Result/Conclusion The area under the curve(AUC)of the prediction model is 0.940,95％CI is 0.928～0.951,the sensitivity is 93.73％,and the specificity is 78.22％.The top three independent factors affecting the rating of a case as grade A are concentrated in the surgical safety checklist,the analysis of the first director's ward round,and the surgical nursing record.The multi-layer perceptron neural network connotation quality prediction model has good prediction efficiency,which provides theoretical references for the connotation quality management of inpatient medical records.

An Electronic Medical Record Security Sharing Scheme Based on Blockchain / 医学信息学杂志

Purpose/Significance Aiming at the difficulty of medical data sharing in traditional medical information systems,an elec-tronic medical record(EMR)security sharing scheme based on blockchain is proposed.Method/Process The blockchain features of de-centralization,tamper-proof and traceability are utilized to build a data security sharing platform and establish security mechanisms such as user authentication,medical record encryption,privacy protection and full traceability to realize the safe sharing of EMR.Result/Conclusion The proposed scheme can resist the potential network attack and meet the needs of patients'privacy protection and confiden-tiality.The feasibility and operation efficiency of the scheme are verified by experiments.

Design of a Precise Prevention and Control Plan for the Cardio-cerebrovascular Diseases Based on Electronic Medical Records / 医学信息学杂志

Purpose/Significance Based on big data,a cardiovascular and cerebrovascular electronic medical record(EMR)analy-sis platform is developed.By utilizing imaging data analysis techniques and clinical document analysis techniques,the platform provides patients with precise diagnosis,treatment plans,scientific administration,prognosis prediction,smart health education prescriptions and other precise services.Method/Process The medical ontology,knowledge rules and knowledge graph for cardiovascular and cerebrovas-cular diseases are developed and constructed by using Protégé.On the basis of constructing a knowledge graph,a knowledge base for clinical diagnosis,treatment,pathological analysis and prognosis judgment of cardiovascular and cerebrovascular diseases is formed.A EMR analysis platform for cardiovascular and cerebrovascular diseases is designed based on the knowledge base.Result/Conclusion The designed cardiovascular and cerebrovascular EMR analysis platform is conducive to providing personalized diagnosis and treatment plans for different populations,and providing patients with various precise diagnosis and treatment services.

Research on the Construction of Hospital Informatization under the Trend of Intelligent Technology / 中国医院管理

The achievements of the national health informatization of China have been remarkable while still facing various challenges,including infrastructure,overall coordination,technical specifications,network security,and public health risks.By conducting a comparative study of the information management of the top 5 best hospitals in the world in 2021,it identifies that for the future of hospital information construction,there is a need for deepening the application of core scenarios such as electronic medical records,mobile medical care,and telemedicine.Further-more,there is a need to expand technology development at the terminal layer,network layer and platform layer.The key to accelerating the construction of national health information is closely integrating the application require-ments of hospital information management with the development trend of intelligent technology.

Discussion on medication law of TCM oral prescriptions for postherpetic neuralgia based on data mining / 国际中医中药杂志

Objective:To analyze the medication law of TCM oral prescriptions in the treatment of postherpetic neuralgia (PHN).Methods:The effective cases and clinical studies about TCM oral prescriptions in the treatment of PHN were retrieved from CNKI, Wanfang Data, VIP, and CBM from January 1, 2002 to December 31, 2021. The medication frequency and drug properties were counted through the Ancient and Modern Medical Record Cloud Platform, and correlation analysis, cluster analysis and complex network analysis were performed.Results:A total of 233 articles were included, involving 243 prescriptions and 191 kinds of Chinese materia medica. There were 20 kinds of Chinese materia medica with frequency >40, most of which have the efficacy of promoting blood circulation to remove blood stasis. The Chinese materia with heat-clearing and detoxifying efficacy were also often used. The properties were mainly warm, mild, slight cold, and cold, tastes were mainly bitter, pungent and sweet, and meridians were mainly liver, spleen and heart meridians. The association rule analysis was used to obtain 15 commonly used TCM groups. The commonly used Chinese materia medica could be clustered into 4 categories. The core prescription obtained by complex network analysis was Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizoma, Corydalis Rhizoma, Bupleuri Radix, Carthami Flos, Paeoniae Radix Alba, Persicae Semen, Chuanxiong Rhizoma, and Rehmanniae Radix.Conclusion:TCM oral prescriptions for the treatment of PHN put promoting blood circulation to remove blood stasis and activating meridians to stop pain in priority, taking into account the clearing heat, regulating qi and blood.

Analysis of disease characteristics and hospitalization burden of elderly patients with cerebrovascular disease based on home page of medical records / 中华老年医学杂志

Objective:To analyze the disease characteristics and hospitalization burden of elderly inpatients with cerebrovascular disease, so as to provide basis for disease prevention, diagnosis, treatment and rehabilitation of elderly patients with multiple chronic conditions.Methods:The data of the first page of medical records of elderly inpatients with cerebrovascular disease from 2015 to 2020 in a comprehensive tertiary hospital in Jiangsu Province were retrospectively collected.Descriptive analysis, variance analysis and multiple linear regression analysis were carried out for the research objects using SPSS statistics and Python complex network methods.Results:A total of 14 657 elderly inpatients with cerebrovascular disease were included.From 2015 to 2020, the number of hospitalizations increased from 1 268 to 4 733, the average number of hospitalizations increased from 2.0 to 2.9, the average length of stay decreased from 11.9 days to 9.1 days, and the average number of illnesses increased from 1.9 to 4.9.The five most common comorbidities associated with cerebrovascular diseases were hypertension, diabetes, ischemic heart disease, other types of heart disease and other respiratory diseases.From 2015 to 2020, the average hospitalization costs of elderly cerebrovascular inpatients decreased from 20588.1 Chinese yuan(CYN)to 15580.9 Chinese yuan(CYN). The hospitalization cost was mainly composed of drug cost(46.6%), diagnosis cost(28.2%)and treatment cost(20.2%). There were significant differences in the average hospitalization expenses among patients with different gender, age, number of admissions, length of stay and number of diseases( P<0.05 for all). Gender, age, number of hospitalizations and length of stay had an impact on hospitalization expenses. Conclusions:The number of inpatients, comorbidities, and hospitalized times of elderly patients with cerebrovascular disease showed an increasing trend, while the number of hospitalization days and the average hospitalization cost showed a downward trend.Comorbidities associated with cerebrovascular diseases should be one of the concerns of chronic disease management in the elderly.

Construction and effectiveness evaluation of surgical complication monitoring mode based on medical record homepage data / 中华医院管理杂志

Objective:To explore the establishment of a surgical complication monitoring mode based on data on the medical record homepage, and analyze its impact on the trend of changes in surgical complication incidence.Methods:A monitoring mode of surgical complication was developed based on the " structure-process-results" framework by using surgical complication rates derived from performance appraisal for a tertiary general hospital in Guangzhou. The number of surgical complications and the number of discharged surgical patients was collected from the hospital from January 2019 to June 2022 through the home page collection system for performance appraisal of national tertiary public hospitals. Descriptive analysis was used to analyze the incidence of surgical complications, and Joinpoint regression was used to analyze the trend of changes in the incidence of surgical complications. Monthly percentage change ( MPC) and average monthly percentage change ( AMPC) were calculated. Results:Since the hospital began implementing the surgical complication monitoring mode in May 2021, the incidence of surgical complications had decreased from 2.55% in June 2021 to 0.82% in June 2022, with an MPC of -5.58% ( P=0.024), which was better than the changes from January 2019 to May 2021 ( MPC=0.18%, P=0.755). Conclusions:The surgical complication monitoring mode constructed by the hospital can effectively reduce the incidence of surgical complications, providing reference for optimizing hospital′s medical quality management process and decision-making mode.

Construction of an electronic medical record sharing convenience service platform based on blockchain / 中华医院管理杂志

Blockchain technology has the advantages of decentralization, secure sharing and tamper resistance, and high privacy, which can solve the current problem of sharing electronic medical records in medical institutions in China. A tertiary hospital established an electronic medical record sharing services convenience service platform based on blockchain in collaboration with China mobile gansu company in September 2021. The hardware architecture of the platform consisted of a hospital data warehouse, a local front-end computer and a blockchain platform. The functional architecture included platform front-end services, the blockchain electronic medical record archiving and service platform. The technical architecture included the underlying blockchain, service layer, interface layer and application layer, which was embedded with asymmetric encryption technology, hash algorithm, smart contract and other technical means, ensuring data ownership and on-demand, controllable, real-time and secure sharing of data. Since the operation of the platform in September 2021, as of October 2022, a tertiary hospital had accumulated 21 545 patient medical records on the chain. The overall operation of the platform was smooth, achieving reliable storage and secure sharing of patient electronic medical records, providing reference for further promoting the interconnection trusted sharing of electronic medical records in medical institutions in China.

Practice of structured electronic medical record design and quality management / 中华医院管理杂志

In order to assist in the standardization and maturity evaluation of national hospital information interconnection, and further standardize the application and management of hospital medical record data, a hospital carried out the practice of design of structured medical records and the corresponding quality management from April 2021. Based on the six sigma quality management method, the hospital had developed universal templates for electronic medical records and a list of candidate electronic medical record templates. The problems faced by medical record data had been analyzed, and improvement strategies had been proposed from three levels: template design, software functionality and management services. The clinical departments were guided to design and develop various structured electronic medical record templates for specialties and specialized diseases, and established a medical record template design and quality management method. The hospital had ultimately designed a total of 614 structured electronic medical record templates that met the actual needs of the hospital. This practice enhanced the scalability of structured templates and quality of the data, and achieved localization and specialization of medical record templates while meeting the requirements of information interconnection and sharing, providing reference for promoting the interconnection and sharing of electronic medical records of hospitals in China.