A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Use of Chinese Herbal Medicine Therapies in Comprehensive Hospitals in Central China: A Parallel Survey in Cancer Patients and Clinicians

Summary： Chinese herbal medicine （CHM）, as the largest application category of traditional Chinese medicine （TCM）, is widely accepted among cancer patients in China. Herbal slice （HS） and Chinese patent drug （CPD） are commonly used CHM in China. This study aimed to investigate the utilization of CHM among clinicians and cancer patients in central China. Five hundred and twenty-five patients and 165 clinicians in 35 comprehensive hospitals in central China were asked to complete an anonymous questionnaire that was designed to evaluate the use of CHM. The results showed that 90.74% clinicians and 72.24% cancer patients used CHM during cancer treatment. The educational backgrounds of the clinicians and the age, education level, annual income, and cancer stage of the cancer patients were re- lated to use of CHM. More than 90% clinicians and cancer patients had used CPD. Comparatively, the percentage of HS use was 10% lower than that of CPD use among clinicians and cancer patients. More clinicians preferred to use CHM after surgery than cancer patients did （20.41% vs. 5.37%）. Enhancing physical fitness and improving performance status were regarded as the most potential effect of CHM on cancer treatment （85.71% among clinicians and 94.07% among cancer patients）, in comparison with directly killing tumor cells （24.49% among clinicians and 31.36% among patients）. As for refusal rea- sons, imprecise efficacy was the unanimous （100%） reason for clinicians＇ rejection of CHM, and 95.58% patients objected to using CHM also for this reason. Furthermore, the side effects of CHM were more concerned by clinicians than by patients （33.33% vs. 15.81%）. In conclusion, our survey revealed that CHM was popularly accepted by clinicians and cancer patients in central China. The reasons of use and rejection of CHM were different between clinicians and cancer patients.

Nursing emergency management practice of COVID-19 in a traditional Chinese medicine hospital

Nursing work is an integral part of hospital work.Under the challenge of the COVID-19 epidemic,it is particularly important to establish a timely and efficient nursing management system.The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills.The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions,rational allocation of human resources,and strengthening personnel training,so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

Onset and Recurrence Characteristics of Chinese Patients with Noncardiogenic Ischemic Stroke in Chinese Medicine Hospitals

Objective:To delineate the onset and recurrence characteristics of noncardiogenic ischemic stroke patients in China.Methods:A prospective,multicenter and registry study was carried out in 2,558 patients at 7 representative clinical sub-centers during November 3,2016 to February 17,2019.A questionnaire was used to collect information of patients regarding CM syndromes and constitutions and associated risk factors.Additionally,stroke recurrence was defined as a primary outcome indicator.Results:A total of 327(12.78%)patients endured recurrence events,1,681(65.72%)patients were men,and the average age was 63.33±9.45 years.Totally 1,741(68.06%)patients suffered first-ever ischemic stroke,1,772(69.27%)patients reported to have hypertension,and1,640(64.11%)of them reported dyslipidemia,1,595(62.35%)patients exhibited small-artery occlusion by The Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification.Specifically,1,271(49.69%)patients were considered as qi-deficient constitution,and 1,227(47.97%)patients were determined as stagnant blood constitution.There were 1,303(50.94%)patients diagnosed as blood stasis syndrome,1,280(50.04%)patients exhibited phlegm and dampness syndrome and 1,012(39.56%)patients demonstrated qi deficiency syndrome.And 1,033(40.38%)patients declared intracranial artery stenosis,and 478(18.69%)patients reported carotid artery stenosis.The plaque in 1,508(41.36%)patients were of mixed.Particularly,41.09%of them demonstrated abnormal levels of glycated hemoglobin(HbA1 c)levels.Conclusions:Recurrence in minor and small-artery stroke cannot be ignored.Hypertension,dyslipidemia,abnormal HbA1 c,intracranial artery stenosis and carotid plaque were more common in stroke patients.Particularly,phlegm-dampness and blood stasis syndromes,as well as qi deficiency and blood stasis constitutions,were still the main manifestations of stroke.(Trial registration at ClinicalTrials.gov,No.NCT03174535)

Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data

Objective:To assess the trends in characteristics,treatments,and outcomes of acute myocardial infarction(AMI)patients in tertiary Chinese medicine(CM)hospitals in China between 2006 and 2013.Methods:This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years(2006 and 2013).Patients admitted to the hospital for AMI were enrolled.Hospital records were used as the data source.Case data were derived regarding baseline characteristics,treatments,and outcomes of patients to assess changes from 2006 to 2013.Logistic regression was used to analyze the relationship between prognosis,general influencing factors of disease,and various treatment measures.Results:Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013(18 were repetitive)were surveyed.A total of 2,311 patients with AMI were enrolled(1,094 cases in 2006 and 1,217 cases in 2013).From 2006 to 2013,the mean age did not significantly change,but the proportion of patients younger than 65 years increased.The prevalence of risk factors such as hypertension,diabetes,and hyperlipidemia also increased.Significant increases were observed in primary percutaneous coronary intervention[20.48%(2006)vs.24.90%(2013)]and revascularization[36.11%(2006)vs.52.42%(2013)].In-hospital mortality decreased from 11.15%in 2006 to 10.60%in 2013.A mortality logistic regression analysis identified reperfusion therapy[odds ratio(OR),0.222;95%confidence interval(CI),0.106–0.464],Chinese patent medicines(OR,0.394;95%CI,0.213–0.727),and CM decoctions(OR,0.196;95%CI,0.109–0.353)as protective factors.Conclusion:Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly,but in-hospital mortality has not significantly decreased.Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.

Risk Factors Associated with Recurrence within 90 Days of Ischemic Stroke Onset in Chinese Medicine Hospital: A National Cross-Sectional Study in China

Objective:The short-and long-term risk factors for stroke recurrence may be different.This study is aimed to determine the risk factors for recurrence within 90 days in patients with ischemic stroke in China.Method:This was cross-sectional registry-based study in Chinese medicine hospitals from eight provinces and ten cities in China between November 3,2016 and May 28,2018.Two thousand one hundred and twenty patients with ischemic stroke aged between 35 and 80 years.Stroke recurrence was defined as an outcome indicator.Computed tomography/magnetic resonance imaging was used as a diagnostic tool for stroke recurrence.Patients’age,sex,height,weight,body mass index(BMI),education level,medical history,family history,smoking,and drinking were recorded.Routine laboratory examinations were performed.Associated factors were investigated by calculating the odds ratio(OR)using logistic regression modeling.Results:In all,2120 patients were included in the study,712(33.6%)of whom were women and 1408(66.4%)were men,with a mean age of 62.84±9.35 years.Eighty-two patients experienced stroke recurrence within 90 days,and the accumulative recurrence rates of stroke were 3.9%(95%confidence interval[CI],3.0%–4.7%).The binary logistic analysis showed that previous history of one(OR=8.113;95%CI,4.497–14.637),two(OR=8.848;95%CI,4.025–9.449),or≥3 ischemic strokes(OR=24.599;95%CI,9.307–65.018),and BMI<18.5 kg/m2(OR=2.842;95%CI,1.000–8.075)were independently associated with stroke recurrence within 90 days.Conclusions:The accumulative recurrence rate of ischemic stroke was 3.9%within 90 days.Number of previous history of ischemic stroke and BMI<18.5 kg/m2 were independent risk factors for stroke recurrence.Medical history and solar terms of ischemic stroke were not found to be associated with stroke recurrence within 90 days.Effective secondary prevention for patients with a previous history of ischemic stroke is urgently needed to address this stroke recurrence burden.

Brief Introduction to Xiyuan Hospital of China Academy of Traditional Chinese Medicine

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湖北省中医医院信息化建设现状分析与思考

目的/意义了解湖北省中医医院信息化建设现状和问题,提出进一步推进中医医院信息化建设的建议。方法/过程基于2022年湖北省中医医院信息化建设现状调查数据,采用描述统计、χ^(2)检验、Fisher检验等方法,阐述湖北省公立中医医院信息化管理部门设置与人员结构、基础设施与资金投入、业务应用系统、信息标准及新一代信息技术应用等方面的现状,剖析存在的主要问题。结果/结论湖北省中医医院信息化建设取得初步成效,但仍应优化信息管理部门职能、充实信息化人才队伍、加强经费投入、强化标准应用、深化中医药特色优势、推进新技术应用等。

中医医院新入职本科护士培训考核评价指标的构建

目的 构建中医医院新入职本科护士培训考核评价指标。方法 通过文献研究、小组讨论,建立中医医院新入职本科护士培训考核评价指标初稿,选取来自7个省份的中华护理学会中医中西医结合护理分会的15名专家进行2轮专家咨询,确定考核评价内容及其权重。结果 2轮专家函询问卷的有效回收率均为100%,专家权威系数分别是0.962、0.980,肯德尔协调系数分别是0.220、0.268(均P<0.05),最终形成的中医医院新入职本科护士培训考核评价指标包括5项一级指标、24项二级指标和77项三级指标。结论 构建的中医医院新入职本科护士培训考核评价指标具有较高的可靠性和科学性,可为中医医院管理者及培训者选拔人才提供参考。

基于双重差分法的DRG付费对中医医院的影响研究

目的:评估按疾病诊断相关分组(DRG)付费对中医医院住院患者例均总费用、费用结构、住院时长、出院人数及中医特色的影响。方法:以某中医类国家区域医疗中心为研究对象,使用双重差分回归模型(DID)分析付费改革政策实施前后医保患者(干预组)与非医保患者(对照组)的各项指标差异,通过平行趋势检验和安慰剂检验证实模型可靠性和稳定性。结果:例均住院总费用、病例数、住院天数、医疗服务收入占比、饮片收入占比等十一项指标的DID交互项系数显著(P<0.05),费用指标回归系数均小于0。饮片使用率、中医非药物疗法收入占比等四项指标DID交互项系数不显著(P>0.05)。结论:DRG付费政策显著降低付费病组例均总费用,其中耗材、医技费用下降显著,费用结构优化,中药饮片费用占比略微下降。应持续关注DRG付费对中医医院影响,进一步扩大样本范围,跟踪分析政策影响,全面评价DRG付费政策对我国中医医疗机构的影响。

基于波士顿矩阵分析法的区域医院科技创新效率研究

目的通过客观评价了解区域医院科技创新效率,推动医院医学学科建设,为医院争创国家区域医疗中心的建设目标提供助力。方法基于医院科技量值指标体系,选取深圳市67家三级医院作为研究对象,分析医院科技创新发展情况,利用波士顿矩阵分析法反映医院科技创新效率。结果深圳市医院间科技创新效率有较大差距:6家医院以相对低的科技投入产生了较高的科技产出,科技创新效率最好;13家医院以较高的科技投入产生了较高的科技产出,具有较好的科技创新效率,科技产出仍可再提升;1家医院科技投入高而科技产出较低,具有较低的科技创新效率,在科技产出方面仍有较大提升空间;47家医院科技投入较低且科技产出也较低,在科技投入及科技产出两个维度仍需发力。结论应依据城市经济高质量发展水平,加强医院科技创新投入水平,引导产出高质量医学科技成果,提升医院科技创新效率。

深圳市公立中医医院医疗服务价格改革历程与思考

通过梳理深圳市公立中医医院医疗服务价格改革历程,分析优势与难点,提出动态调整中医药服务价格,定价应体现中医劳务价值和技术价值,完善医疗服务价格目录,建立中医医疗技术评定指标体系等建议,以助推中医药综合改革,优化深圳中医医疗服务价格改革模式。

2018年至2022年某中医院第二类精神药品使用情况分析

目的促进中医院第二类精神药品的合理使用。方法利用医院信息系统收集安徽省芜湖市中医医院2018年至2022年第二类精神药品的销售数据,分析用药频度(DDDs)、限定日费用(DDC)、排序比(B/A);按第二类精神药品门急诊处方150张/年和病历医嘱50份/年,根据药品说明书、相关指南及专家共识进行处方点评。结果2020年,第二类精神药品销售金额最大,占全院药品销售总金额的1.86%;地佐辛注射液、盐酸曲马多缓释片、咪达唑仑注射液销售金额排名前3;阿普唑仑片、艾司唑仑片、地佐辛注射液的DDDs排名前3;阿普唑仑片的DDC最低;地佐辛注射液的B/A在0.33~1.00之间。共收集1000张处方/医嘱,其中合理处方709张,合理医嘱228条,合理率为93.70%;不合理类型包括用药不规范、不适宜。结论该院2018年至2022年第二类精神药品的使用存在不合理现象,应继续加强对其的管理和监控,确保临床用药安全、合理。

疾病诊断相关分组支付方式对三甲中医院财务管理的影响及应对策略

探讨了疾病诊断相关分组(DRG)支付方式对三甲中医院财务管理的影响并提出应对策略。结合所在医院随机抽取的某月各科室相关数据,运用DRG支付方式下的相应指标并结合波士顿矩阵理论模型进行全面综合评价分析。2023年1月,所在医院5个科室CMI值高于全院平均水平,且盈余情况良好;8个科室CMI值低于全院平均水平,但有盈余;14个科室CMI值低于全院平均水平,且还有亏损;8个科室CMI值高于全院平均水平,却有亏损。DRG支付方式对三甲中医院来说,既是机遇也是挑战,对三甲中医院信息化数据系统、成本核算精细化提出高要求,对预算管理、拓展收入增长内涵提出新要求。三甲中医院应重视病案质量主体培训,强化成本内控,转为质量效益型运营管理模式,应用临床路径以“提质控费”,发挥中医药优势学科,结合中医治疗特点来制定适合中医发展的DRG支付方式。

“六一”绩效管理模式赋能中医医院高质量发展实践探索

目的探索构建公立中医医院内部绩效考核管理体系,实现以绩效“国考”推动公立医院高质量发展的目标。方法在分析绩效考核过程中存在的问题与面临的困境的基础上,以三级公立中医医院绩效考核指标为导向,创新“六一”绩效管理策略和手段,即坚持“一盘棋”整体规划、“一条链”融会贯通、“一张网”全面覆盖、“一条龙”全程服务、“一本账”精细管理、“一个螺旋”持续改进,建立医院内部绩效考核管理体系。结果医院内涵建设取得一定成效,中医特色优势持续彰显,质量安全内涵日趋深化,运营管理效率稳步提升,学科建设成果实现突破,人才培养成效显著,医患双方满意度提升明显。结论构建科学、规范、标准的医院内部绩效考核管理体系,确保国家三级公立中医医院绩效考核工作落实到位,促进公立医院高质量发展。

4种治疗糖尿病周围神经病变补气活血类中成药的卫生技术评估

目的为临床选择糖尿病周围神经病变(DPN)治疗用补气活血类中成药提供参考。方法参考《医疗机构中成药遴选专家共识(第一版)》,结合临床实际,制订药物卫生技术评估细则,参考药品说明书、临床指南和文献,对4种中成药的安全性、有效性、经济性、适宜性、创新性、可及性、传承性进行评分,并计算总分。结果通心络胶囊、木丹颗粒、糖脉康颗粒、芪蛭降糖胶囊的评分分别为74.5分、72分、64.5分、57分。结论临床在选择治疗DPN的补气活血类中成药时,相对于糖脉康颗粒、芪蛭降糖胶囊,建议优先使用木丹颗粒、通心络胶囊。

国家医院绩效考核引领下的中医院发展策略探讨

随着国家对医疗卫生事业的重视和投入不断加大,公立医院的绩效考核成为衡量医院综合能力的重要标准。在本轮国家公立三级中医院绩效考核中,宁波市中医院以绩效改革为引擎,推动精细化管理,注重医疗质量和行为规范考核,建立科学的绩效分配考核体系,按劳分配,优劳优酬。此外,医院还注重学科建设,发展中医特色专科,加强优势品牌专科和保障性专科的建设,提升医疗质量和声誉,推动中医药事业健康发展。

强内涵 促发展——现代中医医院建筑形态布局研究

结合中医医院建筑的发展历程和时代需求,对我国当今中医医院建筑形态布局的类型进行归纳,分析总结各类形态布局特点,探讨中医医院建筑形态布局的设计方法,提出与自然环境有机结合、传承创新建筑文化、功能布局高效便捷、弹性设计等设计策略,为现代中医医院建筑形态布局设计提供参考。

某三甲医院2022年产科中成药不合理使用情况分析

目的:促进医院产科中成药的合理应用,保障孕产妇及婴儿用药安全。方法:利用临床用药决策支持软件对某三甲医院产科2022年度开具的中成药处方进行系统自动点评筛选,对筛选出的问题处方再次进行人工点评,对处方存在的问题类型进行归纳汇总,分析原因。结果:该院产科2022年开具中成药处方(含住院医嘱)共计14886张,系统智能筛选出问题处方3987张(26.78%),人工点评后确认存在用药不合理情况的处方199张(1.34%),其中不合理儿童药品处方19张(9.55%)。结论:该院产科2022年仍存在不合理使用中成药情况,医院需及时采取积极的干预措施,以保障产科用药规范合理,保障患者的安全。