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DRG支付方式改革对医院病组结构的影响
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作者 杨喜旺 冯文 《广西医学》 CAS 2024年第6期895-900,共6页
目的分析疾病诊断相关分组(DRG)支付方式改革对医院病组结构的影响。方法以某市唯一一家三级甲等医院作为样本医院,提取其2017—2019年及2021年依据国家医疗保障疾病诊断相关分组(CHS‑DRG)1.0分组方案入组的住院病例结算数据。分析4年... 目的分析疾病诊断相关分组(DRG)支付方式改革对医院病组结构的影响。方法以某市唯一一家三级甲等医院作为样本医院,提取其2017—2019年及2021年依据国家医疗保障疾病诊断相关分组(CHS‑DRG)1.0分组方案入组的住院病例结算数据。分析4年间该院住院病例的基本情况。利用服务组合赫芬达尔‑赫希曼指数(SPEC)描述该院的病组结构集中度;采用中断时间序列分析(ITSA)评估DRG支付方式改革前后该院SPEC的变化趋势。采用多元线性回归模型分析该院病组选择偏好的影响因素。结果(1)2017—2021年(不含2020年),该院的总权重、DRG病组数、病例组合指数均呈增长趋势。(2)ITSA结果显示,在改革前,该院的SPEC每月下降0.0002(P<0.05),但改革后SPEC每月较改革前多增长0.0005(P<0.05),即在改革后SPEC每月上升0.0003。(3)改革后,DRG病组权重每增加1,DRG病组占比增长率较改革前多增加6.114%(P<0.05);DRG病组市场份额每增加1%,DRG病组占比增长率较改革前多增加1.066%(P<0.05)。结论DRG支付方式改革使得样本医院收缩住院服务范围,病组结构更加集中,并且样本医院在改革后更加注重符合自身功能定位的高难度病组的发展。 展开更多
关键词 诊断相关分 支付方式 病组结构 住院服务
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北京市医药分开综合改革政策对住院病组结构的影响分析 被引量:5
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作者 佟朝霞 陈宇 +1 位作者 孔晴宇 魏永祥 《中国卫生质量管理》 2018年第5期25-27,共3页
目的分析北京实施医药分开综合改革政策对医院医疗收入、费用结构及病组结构等方面产生的影响,为深化医改提供依据。方法利用DRGs管理工具对2017年4月-6月出院病例与2016年同期病例进行回顾性分析。结果出院人次及住院医疗总收入同比上... 目的分析北京实施医药分开综合改革政策对医院医疗收入、费用结构及病组结构等方面产生的影响,为深化医改提供依据。方法利用DRGs管理工具对2017年4月-6月出院病例与2016年同期病例进行回顾性分析。结果出院人次及住院医疗总收入同比上涨,费用结构中药品收入下降,耗材费用和医疗服务类收入增加。病组结构变化主要是常见病、多发病、单一疾病住院人数下降,合并症患者增加。结论医改措施初见成效,推动了分级诊疗的落实,还需进一步深化改革,尽快调整医疗技术类服务价格和加强医用耗材管控。 展开更多
关键词 医药分开综合改革 住院费用 DRGs分 病组结构
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新农合DRG支付方式改革对肌肉骨骼系统疾病病组结构的影响 被引量:1
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作者 郭在新 李璟媛 冯文 《医学与社会》 北大核心 2022年第8期89-93,共5页
目的:分析DRG支付方式改革后肌肉、骨骼疾病及功能障碍(MDCI)病组患者数量及其结构的变化,探讨疾病的疑难程度、控费效果与患者结构变化的关系。方法:利用某市新农合DRG改革试点医院2016-2019年的MDCI出院患者数据,通过统计描述和中断... 目的:分析DRG支付方式改革后肌肉、骨骼疾病及功能障碍(MDCI)病组患者数量及其结构的变化,探讨疾病的疑难程度、控费效果与患者结构变化的关系。方法:利用某市新农合DRG改革试点医院2016-2019年的MDCI出院患者数据,通过统计描述和中断时间序列分析改革前后二三级医院MDCI病例数、病例组合指数、次均费用的变化,通过多重线性回归分析权重和次均费用变化对患者结构的影响。结果:改革后二三级试点医院MDCI月度病例数涨势加快,病例组合指数分别由改革前的1.55、1.56增至2.13、2.31,次均费用涨幅超40%。多重线性回归分析结果显示权重、次均费用增量和二者的交互作用影响二级医院MDCI的患者结构变化(P<0.01),权重和次均费用增量影响三级医院MDCI的患者结构变化(P<0.05)。结论:DRG支付方式改革后,二三级医院MDCI患者数量及病例组合指数大幅上涨,医院控制成本的动力不足,高权重和存在费用上涨空间会使患者规模扩张的可能性增加。 展开更多
关键词 DRG 支付方式改革 新农合 肌肉骨骼系统疾 病组结构
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应用DRG病组收治结构测算平均住院日目标值 被引量:2
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作者 李超 潘琦 +2 位作者 盖媛媛 吴锁薇 陈彤 《中国病案》 2023年第4期38-41,共4页
目的探索应用病组收治结构制定平均住院日目标值的方法,科学合理缩短平均住院日。方法收集某院2018年1月1日-2019年12月31日出院患者住院病案首页数据,通过单因素方差分析方法,验证ALOS目标值测算方法一(纳入病组收治结构因素)和方法二... 目的探索应用病组收治结构制定平均住院日目标值的方法,科学合理缩短平均住院日。方法收集某院2018年1月1日-2019年12月31日出院患者住院病案首页数据,通过单因素方差分析方法,验证ALOS目标值测算方法一(纳入病组收治结构因素)和方法二(直接使用北京市住院医疗服务绩效平台各专业组ALOS标杆值)的测算值与实际值的统计学差异。运用多重比较分析方法,进一步比较两种方法的测算精确性。结果根据单因素方差分析检验结果,两组方法的测算值与实际值的P值为0.98,表明两种测算方法测算的ALOS目标值与实际值均无统计学差异。进一步采用多重比较分析法来判断两种方法的测算精度,2019年实际平均住院日为7.56天,方法一全院测算值为7.54天,各科室测算值与实际值组间标准差为1.03。方法二全院测算值为7.82天,各科室测算值与实际值组间标准差为1.80。结论纳入历史病组收治结构因素测算ALOS目标值方法准确性、科学性、可操作性更强,更适合医疗机构作为每年度平均住院日目标值的测算方法。 展开更多
关键词 DRG 平均住院日 目标 测算 病组结构
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基于DRGs的科室性质对神经系统住院费用的研究 被引量:1
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作者 周益萍 秦语阳 +1 位作者 蒋文博 刘莉 《现代医院管理》 2021年第2期89-91,共3页
目的探讨神经系统患者中内科治疗患者住院费用的影响因素,为规范提高资源利用效率提供参考。方法数据来源于2019年9月至12月某医院神经系统中非手术治疗的470例患者的病案首页,利用单因素分析和线性回归分析,探索该部分病例在内科科室... 目的探讨神经系统患者中内科治疗患者住院费用的影响因素,为规范提高资源利用效率提供参考。方法数据来源于2019年9月至12月某医院神经系统中非手术治疗的470例患者的病案首页,利用单因素分析和线性回归分析,探索该部分病例在内科科室和外科科室治疗的住院费用上的差异。结果对于进入神经系统的内科治疗病组病例而言,出院科室为神经内科和神经外科在住院总费用上有显著差异(P<0.05),神经外科出院的患者总费用高于神经内科,差异具有显著效益(P<0.05)。结论对于神经系统疾病内科治疗患者,在相同的疑难程度和疾病转归下,外科科室收治会消耗更多的医疗资源,产生更高的医疗费用,因此,不鼓励外科收治内科病人,建议外科将优质资源服务于有明显手术指征的患者,提高手术患者占比,调整病组结构,实现资源的最大化利用和科室的精细化管理。 展开更多
关键词 诊断相关分 住院医疗费用 病组结构 精细化管理
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Histopathological Observation of Lymphocystis Disease and Lymphocystis Disease Virus (LCDV) Detection in Cultured Diseased Sebastes schlegeli 被引量:6
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作者 SHENG Xiuzhen ZHAN Wenbin XU Songjuan CHENG Shunfeng 《Journal of Ocean University of China》 SCIE CAS 2007年第4期378-382,共5页
Lymphocystis nodules occurring in the cultured sting fish Sebastes schlegeli were observed under light and electron microscope. Lymphocystis disease virus (LCDV) in the tissues of diseased fish was detected with indir... Lymphocystis nodules occurring in the cultured sting fish Sebastes schlegeli were observed under light and electron microscope. Lymphocystis disease virus (LCDV) in the tissues of diseased fish was detected with indirect immunofluorescence test (IFAT). Results showed that lymphocystis cells had overly irregular nuclei, basophilic intracytoplasmic inclusion bodies with virions budding from the surface, and hyaline capsules outside the cell membrane. Numerous virus particles about 200 nm in diameter scat- tered in the cytoplasm, electron-dense particles 70-80 nm in diameter filled in perinuclear cisterna, and membrane-enveloped parti- cles with electron-dense core of 70-80 nm appeared around cellular nucleus. IFAT using monoclonal antibody against LCDV from Paralichthys olivaceus revealed that specific green fluorescence was present in the cytoplasm of lymphocystis cells, epithelium of stomach, gill lamellae, and muscular fibers under epidermis of S. schlegeli, just as that in the cytoplasm of lymphocystis cells of P. olivaceus, suggesting the presence of LCDV in these tissues. 展开更多
关键词 sting fish Sebastes schlegeli lymphocystis disease HISTOPATHOLOGY ULTRASTRUCTURE indirect immunofluorescence test
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Time-effect relationship of acupuncture on histopathology, ultrastructure, and neuroethology in the acute phase of cerebral hemorrhage 被引量:28
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作者 Zuo-Wei Li Xiao-Nan Zheng Ping Li 《Neural Regeneration Research》 SCIE CAS CSCD 2019年第1期107-113,共7页
Many clinical studies have addressed the treatment of acute cerebral hemorrhage using acupuncture. However, few studies have examined the relationship between time of acupuncture and curative effect on cerebral hemorr... Many clinical studies have addressed the treatment of acute cerebral hemorrhage using acupuncture. However, few studies have examined the relationship between time of acupuncture and curative effect on cerebral hemorrhage. By observing the effect of acupuncture on changes in histopathology, ultrastructure, and neuroethology in a cerebral hemorrhage model of rats, we have directly examined the time-effect relationship of acupuncture. The rat model of cerebral hemorrhage was produced by slowly injecting autologous blood to the right caudate nucleus. The experimental groups were: 3-, 9-, 24-, and 48-hour model groups; and 3-, 9-, 24-, and 48-hour acupuncture groups. The sham-operation group was used for comparison. Acupuncture was performed at the Neiguan(PC6) and Renzhong(DU26) acupoints, twice a day, 6 hours apart, for 5 consecutive days. Brain tissue changes were observed by light microscopy and transmission electron microscopy. Neuroethology was assessed using Bederson and Longa scores. Our results show that compared with the sham-operation and model groups, Bederson and Longa scores were lower in each acupuncture group, with visibly improved histopathology and brain tissue ultrastructure. Further, the results were better in the 3-and 9-hour acupuncture groups than the 24-and 48-hour acupuncture groups. Our findings show that acupuncture treatment can relieve pathological and ultrastructural deterioration and neurological impairment caused by the acute phase of cerebral hemorrhage, and may protect brain tissue during this period. In addition, earlier acupuncture intervention following cerebral hemorrhage(by 3 or 9 hours) is associated with a better treatment outcome. 展开更多
关键词 nerve regeneration ACUPUNCTURE acute phase cerebral hemorrhage time-effect ULTRASTRUCTURE FUNCTION HISTOPATHOLOGY NEUROETHOLOGY brain injury neural regeneration
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Effects of four regulating-intestine prescriptions on pathology and ultrastructure of colon tissue in rats with ulcerative colitis 被引量:19
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作者 Heng Fan Ming-Yi Qiu +3 位作者 Jia-Jun Mei Guan-Xin Shen Song-Lin Liu Rui Chen 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第31期4800-4806,共7页
AIM: To observe different histomorphologic changes of ulcerative colitis (UC) rats that were treated with four regulating-intestine prescriptions (FRIP), to investigate the curative effects of FRIP and to analyze thei... AIM: To observe different histomorphologic changes of ulcerative colitis (UC) rats that were treated with four regulating-intestine prescriptions (FRIP), to investigate the curative effects of FRIP and to analyze their treatment mechanism.METHODS: The UC rat model was made by the method of 2,4-dinitro chloro benzene (DNCB) immunity and acetic acid local enema. Ninety-eight SD rats were randomly divided into seven groups, namely, the normal control group, model group, salicylazosulfapyridine (SASP) group,Wumeiwan (WMW) group, Baitouwengtang (BTWT) group,Senglingbaishusan (SLBSS) group, and Tongxieyaofang (TXYF) group. Each group had 14 rats (with equal ratio of male and female). The six animal model groups of UC-SASP, TXYF, WMW, BTWT, SLBSS, TXYF-were treated by distilled water except the normal control group. Changes of the rat's general conditions after treatment were respectively observed, the colon tissue damage scores were given out, the pathology of colonic mucosa and changes of ultrastructure were analyzed.RESULTS: Different pathological changes on histology were shown after treatment by FRIP. The colon tissue damage score in model group was higher than that of FRIP groups and SASP group (q = 4.59, 4.77, P<0.05 or q = 5.48,6.25, 5.97, P<0.01). The scores of WMW group, BTWT group and SLBSS group were lower than that of SASP (q = 4.13, P<0.05 or q = 5.31, 5.12, P<0.01). There was no remarkable difference between the damage score of TXYF group and SASP group (q = 3.75, P>0.05). In addition, some apoptosis cells were found in the pathologic control group.CONCLUSION: The model made with DNCB and acetic acid was successful, and FRIP had better curative effect and WMW was the best curative effect, BTW, SLBSS and TXYF were similar to SASP, and we discovered that apoptosis was possibly related to UC. 展开更多
关键词 Ulcerative colitis TCM therapy Experimentalresearch PATHOLOGY ULTRASTRUCTURE Apoptosis
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Inhibition of Japanese Encephalitis Virus Infection by Flavivirus Recombinant E Protein Domain Ⅲ 被引量:3
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作者 Jingjing Fan Yi Liu +2 位作者 Xuping Xie Bo Zhang Zhiming Yuan 《Virologica Sinica》 SCIE CAS CSCD 2013年第3期152-160,共9页
Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus closely related to the human pathogens including yellow fever virus, dengue virus and West Nile virus. There are currently no effective antiviral therap... Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus closely related to the human pathogens including yellow fever virus, dengue virus and West Nile virus. There are currently no effective antiviral therapies for all of the flavivirus and only a few highly effective vaccines are licensed for human use. In this paper, the E protein domain III (DIII) of six heterologous flaviviruses (DENV1-4, WNV and JEV) was expressed in Escherichia coli successfully. The proteins were purified after a solubilization and refolding procedure, characterized by SDS-PAGE and Western blotting. Competitive inhibition showed that all recombinant flavivirus DIII proteins blocked the entry of JEV into BHK-21 cells. Further studies indicated that antibodies induced by the soluble recombinant flavivirus DIII partially protected mice against lethal JEV challenge. These results demonstrated that recombinant flavivirus DIII proteins could inhibit JEV infection competitively, and immunization with proper folding flavivirus DIII induced cross-protection against JEV infection in mice, implying a possible role of DIII for the cross-protection among flavivirus as well as its use in antigens for immunization in animal models. 展开更多
关键词 Japanese encephalitis virus E protein domain III CROSS-PROTECTION ANTIBODY
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Molecular Characterization of China Human Rabies Vaccine Strains 被引量:2
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作者 Xiaoyan Tao Na Han +3 位作者 Zhenyang Guo Qing Tang Simon Rayner Guodong Liang 《Virologica Sinica》 SCIE CAS CSCD 2013年第2期116-123,共8页
To understand the molecular characteristics of China human rabies vaccine strains, we report the full-length genome of the aG strain and present a comprehensive analysis of this strain and almost all available lyssavi... To understand the molecular characteristics of China human rabies vaccine strains, we report the full-length genome of the aG strain and present a comprehensive analysis of this strain and almost all available lyssavirus genomes (58 strains) from GenBank (as of Jan 6, 2011). It is generally considered that the G protein plays a predominant role in determining the pathogenicity of the virus, to this end we predicted the tertiary structure of the G protein of aG strain, CTN 181 strain and wild type strain HN 10 based on the crystal structure of Vesicular stomatitis virus (VSV) G. The predicted RABV G structure has a similar topology to VSV G and the ectodomain can be divided into 4 distinct domains DI - DIV. By mapping the characterized mutations to this structure between China vaccine strains and their close street strains, we speculate that the G303(P-H) mutations of CTN181 and HN10 causing D II 3D change may be associated with the attenuated virulence in both strains. Specifically, the two signature mutations (G165P and G231P) in the aG strain are withinβsheets, suggesting that both sites are of structural importance. 展开更多
关键词 Rabies virus LYSSAVIRUS GENOME GLYCOPROTEIN
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The Biology of Chilo Iridescent Virus
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作者 Remziye Nalac1oglu Ikbal Agah Ince Zihni Demirbag 《Virologica Sinica》 SCIE CAS CSCD 2009年第4期285-294,共10页
Chilo iridescent virus (CIV) is the type species for genus Iridovirus, and belongs to the family Iridoviridae. Since the discovery of CIV in 1966, many attempts were made to elucidate the viral genome structure. The v... Chilo iridescent virus (CIV) is the type species for genus Iridovirus, and belongs to the family Iridoviridae. Since the discovery of CIV in 1966, many attempts were made to elucidate the viral genome structure. The virions contain a single linear ds DNA molecule that is circularly permuted and terminally redundant. The genome of CIV has been entirely sequenced. The CIV virion consists of an unusual three-layer structure containing an outer proteinaceous capsid, an intermediate lipid membrane, and a core DNA-protein complex containing the genome. CIV has a broad host spectrum and has, in general, a limited mortality effect on its hosts. Up to now there have been several studies about CIV describing its structure, ecology, and molecular biology. In this review study we present all these studies together to describe the CIV. 展开更多
关键词 Chilo iridescent virus IRIDOVIRUS Host range Virus replication Molecular biology
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Diagnosis and Differential Diagnosis of Rhabdoid Meningioma: One Case Report and Literature Review
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作者 Huixia Han Pine Du +1 位作者 Yan Zhang Yongjian Deng 《Clinical oncology and cancer researeh》 CAS CSCD 2009年第4期303-306,共4页
Introduction Rhabdoid meningioma (RM) is a special type of meningioma, The pathologic features of RM include sheets of rhabdoid tumor cells with or without the findings typical of conventional meningiomas. Since the... Introduction Rhabdoid meningioma (RM) is a special type of meningioma, The pathologic features of RM include sheets of rhabdoid tumor cells with or without the findings typical of conventional meningiomas. Since the disease is rare, and the histologic structure similar to that of other tumors, misdiagnosis and failure to include the entity in the differentiation can occur from time to time. In this article, the pathologic features and immunophenotype of RM are analyzed, in combination with analysis of a case treated at our institution and a review of the literature. 展开更多
关键词 rhabdoid meningioma pathologic feature differential diagnosis.
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Structural Changes of Lignified Tissues from Sugarcane Leaves Induced by Smut (Sporisorium scitamineum) Virulence Factors
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作者 Borja Alarcon Rocio Santiago +1 位作者 Carlos Vicente Maria Estrella Legaz 《Journal of Life Sciences》 2012年第3期287-299,共13页
Sugarcane leaf shows the classical arrangement of cells, which defines a C4 species. Vascular bundles consist of xylem, phloem and fibres, surrounded by an outer layer ofsclereids and an inner ring of stone cells asso... Sugarcane leaf shows the classical arrangement of cells, which defines a C4 species. Vascular bundles consist of xylem, phloem and fibres, surrounded by an outer layer ofsclereids and an inner ring of stone cells associated with the phloem. Some sclereids located below and above the vascular bundles act as docking cells and connect the vascular bundle to the internal surfaces of upper and lower layers of the epidermis. A compact mass ofsclereids occupies the total internal volume of the leaf edge. Neither docking cells nor the internal mass of sclereids in the edge were markedly coloured by phloroglucinol, indicating the absence of lignin in their cell walls. However, such staining indicated that fibres of the vascular bundle and the external layer of sclereids were strongly lignified. Incubation of leaf discs with an virulence factors produced by the pathogen Sporisorium scitamineum increased the thickness of the lignified cell walls of sclereids as well as the mid and small xylem vessels, as a possible mechanical defence response to the potential entry of the pathogen. This mechanism was mainly revealed for the resistant cv. Mayari 55-14, whereas lignification decreased for the susceptible cv. B 42231. 展开更多
关键词 Saccharum officinarum Sporisorium scitamineum fungal virulence factors LIGNIFICATION plant defence sclereids.
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Spectrin:Structure, function and disease 被引量:2
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作者 ZHANG Rui ZHANG ChenYu +1 位作者 ZHAO Qi LI DongHai 《Science China(Life Sciences)》 SCIE CAS 2013年第12期1076-1085,共10页
Spectrin is a large,cytoskeletal,and heterodimeric protein composed of modular structure of and subunits,it typically contains 106 contiguous amino acid sequence motifs called"spectrin repeats".Spectrin is c... Spectrin is a large,cytoskeletal,and heterodimeric protein composed of modular structure of and subunits,it typically contains 106 contiguous amino acid sequence motifs called"spectrin repeats".Spectrin is crucial for maintaining the stability and structure of the cell membrane and the shape of a cell.Moreover,it contributes to diverse cell functions such as cell adhesion,cell spreading,and the cell cycle.Mutations of spectrin lead to various human diseases such as hereditary hemolytic anemia,type 5 spinocerebellar ataxia,cancer,as well as others.This review focuses on recent advances in determining the structure and function of spectrin as well as its role in disease. 展开更多
关键词 ERYTHROCYTE SPECTRIN cell cycle mass spectrometry DISEASE
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Viral proteomics: The emerging cutting-edge of virus research 被引量:3
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作者 ZHOU ShengTao LIU Rui +2 位作者 ZHAO Xia HUANG CanHua WEI YuQuan 《Science China(Life Sciences)》 SCIE CAS 2011年第6期502-512,共11页
Viruses replicate and proliferate in host cells while continuously adjusting to and modulating the host environment.They encode a wide spectrum of multifunctional proteins,which interplay with and modify proteins in h... Viruses replicate and proliferate in host cells while continuously adjusting to and modulating the host environment.They encode a wide spectrum of multifunctional proteins,which interplay with and modify proteins in host cells.Viral genomes were chronologically the first to be sequenced.However,the corresponding viral proteomes,the alterations of host proteomes upon viral infection,and the dynamic nature of proteins,such as post-translational modifications,enzymatic cleavage,and activation or destruction by proteolysis,remain largely unknown.Emerging high-throughput techniques,in particular quantitative or semi-quantitative mass spectrometry-based proteomics analysis of viral and cellular proteomes,have been applied to define viruses and their interactions with their hosts.Here,we review the major areas of viral proteomics,including virion proteomics,structural proteomics,viral protein interactomics,and changes to the host cell proteome upon viral infection. 展开更多
关键词 VIRUS PROTEOMICS virion proteomics virus host interaction
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Cancer:A proteomic disease 被引量:8
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作者 LI GuoQing XIAO ZheFeng +3 位作者 LIU JianPing LI Cui LI Feng CHEN ZhuChu 《Science China(Life Sciences)》 SCIE CAS 2011年第5期403-408,共6页
The development of cancer is a pathological process involving multiple environmental carcinogenic factors and genetic alterations.For decades,cancer researchers have focused on genomic and transcriptomic analyses.The ... The development of cancer is a pathological process involving multiple environmental carcinogenic factors and genetic alterations.For decades,cancer researchers have focused on genomic and transcriptomic analyses.The completion of the Human Genome Project has opened the door to the post-genome era and oncoproteomics.Proteins play a critical role in tumorigenesis and influence the differences between normal cells and malignant cells.This report proposes the concept that cancer is a proteomic disease.This concept is based on examining protein expression profiles,post-translational modifications,and protein-protein interactions in carcinogenesis using recent advances in comparative,functional and structural proteomics.This approach provides a new way of viewing carcinogenesis,presents new clues in biomarker discovery for cancer diagnosis and therapy,and reveals important scientific findings and their significance to clinical applications. 展开更多
关键词 CANCER proteomic disease protein profiling modification-specific proteome protein-protein interaction
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