一种基于血液检测的诊断和预测HBV相关疾病的弹性方法

Chronic hepatitis B virus(HBV)infection,which threatens global public health,is a major contributor to liver-related morbidity and mortality.Examinations for liver diseases related to chronic HBV infection-including laboratory tests,ultrasounds,computed tomography(CT),and liver biopsies-may take up medical resources,particularly since they overlap in most instances.Thus,there is an urgent need to establish an economical and effective diagnosis method in order to streamline the medical process for HBV-related disea ses.Using complex network models constructed based on clinical blood tests,we provide such a method by defining the novel measure of functional resilience to assess patients’liver conditions.By combining network models and dynamics,we discovered the pivotal items and their corresponding thresholds,which can guide further research on preventing disease deterioration in critical states of these diseases.The macro-averaged precision of our method,functional resilience,is84.74%,whereas the macro-averaged precision of physicians’experience without assistance from imaging or biopsy is 55.63%.From an economic perspective,our approach could save the equivalent of at least30 USD per visit for most Chinese patients and at least 400 USD per visit for most US patients,compared with general diagnostic methods.Globally,this will add to savings of at least 10.5 billion USD annually.Our method can comprehensively evaluate the condition of patients’livers and help avert the waste of medical resources during the diagnosis of liver disease by reducing excessive imaging exams.

Effects of New Rural Cooperative Medical Scheme on Medical Service Utilization and Medical Expense Control of Inpatients： A 3-year Empirical Study of Hainan Province in China

Background： The New Rural Cooperative Medical Scheme （NCMS） has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years. Methods： The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS. Results： In the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund ofNCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively. Conclusions： With the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers＇ medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.

Trends in use and costs of prescription medication in patients with type 1 diabetes: 9-year follow-up after kidney transplantation

Aims: Weestimated long-term trends in prescription medication utilization and costs in patients with type 1 diabetes in two different transplant cohorts (Group 1: transplantation 1986-1999,n = 180;Group 2: transplantation 2000-2008, n = 150). Methods: Data obtained from the Finnish Diabetic Nephropathy Study were linked with the Drug Prescription Register (purchases of medications 1995-2009). Generalized linear mixed models under gamma distribution were used to evaluate the medication costs. Results: The total costs of medication decreased (Group 1 from€11,290 to €8760;Group 2 from €12,800 to €9790)during the follow-up (P< 0.0001). The sametrend was observed for immunosuppressive drugcosts (P< 0.0001). Although the cost profiles were similar for the groups (P= 0.9), the cost level in Group 2 was higher than in Group 1 (P< 0.0001). In Group 1 the most common immunosuppressive combination was cyclosporine, azathioprine and corticosteroid, while cyclosporine, mycophenolate mofetil (MMF) with/without corticosteroid was the most common in Group 2. The estimated average costs of cyclosporine in combination withMMFwere 84% (€4130) higher than with azathioprine. Conclusions: Since diabetes or other drugs had only marginal impact on the total costs, the decreasing trend wasmainly due to the costs of immunosuppressants.This finding is consistent with the recent guidelines which recommend reducing doses of immunosuppressants over time to minimize sideeffects.The cost levels differed depending on the combinations of immunosuppressive drugs in use. Those who had MMF in the regimen generated higher costs.

Can Tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation？

Background：It is not clear whether the benefits oftracheostomy remain the same in the population.This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients.Methods：Data were from the medical claims data in Taiwan.A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified.Among them,645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period,and successful weaning and medical utilization during hospitalization.Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes.Results：The tracheostomy rate was 30％,and 55％ of tracheostomies were performed within 30 days of mechanical ventilation.After adjustments,patients with tracheostomy were at a lower risk of death during hospitalization （hazard ratio [HR] =0.51;95％ confidence interval [CI] =0.43-0.61） and 5-year observation （HR =0.73;95％ CI =0.66-0.81）,and a lower probability of successful weaning （HR =0.88;95％ CI =0.79-0.99）.Higher medical use was also observed in patients with tracheostomy.Conclusions：The beneficial effect for tracheostomy observed in our data was the reduction of death.However,patients with tracheostomy were less likely to wean and more likely to consume medical resources.

Medical service utilisation, economic burden and health status of patients with rare diseases in China

Many patients with rare diseases not only suffer from more severe conditions but often receive less disease management, which is one significant public health concern globally. Few practice-based surveys focus on the care of patients with rare diseases. In the present study, we aimed to investigate medical service utilization, economic burden and health status of patients with rare diseases in China. A cross-sectional questionnaire survey focusing on patients with rare diseases was conducted. Descriptive analysis was conducted to examine the sociodemographic characteristics, medical service utilization, economic burden and health status. Logistic regression analysis was applied to explore influencing factors of self-rated health. A total of 982 patients with 81 types of diseases were included in this survey. We found that 58.2% of patients experienced misdiagnosis, and 35.2% of the patients were misdiagnosed for at least five times. Moreover, 65.8% of patients traveled to hospitals to seek medical services, and 92.1% of patients paid expenses for their treatment. However, only 1.3% of patients could afford their medical expenditure without debts, and 86.8% of patients regarded their health status as bad or moderate. Significant factors correlated with health status were economic status, gender, age, employment and household size. From this study, the accessibility of medical service utilization, the affordability of medical economic burden, and the condition of health status for patients with rare disease in China were considerably poor. Basic medical insurance did not play its role in improving the utilization of medical services and the affordability of medical costs. Social support should be encouraged to improve patients＇ health status.