Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model

BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.

Association of ABO blood groups with the severity of coronary artery disease: a cross-sectional study

Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. Results The Gensini score was significantly higher in the blood group A than in the non-A groups(41.2 ± 32 vs. 38 ± 27;P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD(β= 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score(P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. Conclusion In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Large Cohort Data Based Group or Community Disease Prevention Design Strategy: Strong Heart Study

Background and Objective: A multitude of large cohort studies have data on incidence rates and predictors of various chronic diseases. However, approaches for utilization of these costly collected data and translation of these?valuable results to inform and guide clinical disease prevention practice are?not well developed. In this paper we proposed a novel conceptual group/community disease prevention design strategy based on large cohort study data. Methods and Results: The data from participants (n = 3516;2056 women) aged 45 to 74 years and the diabetes risk prediction model from Strong Heart Study were used. The Strong Heart Study is a population-based cohort study of cardiovascular disease and its risk factors in American Indians. A conceptual group/community disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for group diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to the prevention design issues. These issues include complex associations of a disease with its combined and correlated risk factors, individual differences, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustration example can be analogously adopted and applied for other diseases preventions. The proposed strategy for a target group/community in a population provides a way to translate and apply epidemiological study results to clinical disease prevention practice.

Advantageous tactics with certain probiotics for the treatment of graft-versus-host-disease after hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation(HSCT)becomes a standard form of cellular therapy for patients with malignant diseases.HSCT is the first-choice of immunotherapy,although HSCT can be associated with many complications such as graft-versus-host disease(GVHD)which is a major cause of morbidity and mortality after allogeneic HSCT.It has been shown that certain gut microbiota could exert protective and/or regenerative immunomodulatory effects by the production of short-chain fatty acids(SCFAs)such as butyrate in the experimental models of GVHD after allogeneic HSCT.Loss of gut commensal bacteria which can produce SCFAs may worsen dysbiosis,increasing the risk of GVHD.Expression of G-protein coupled receptors such as GPR41 seems to be upre-gulated in the presence of commensal bacteria,which might be associated with the biology of regulatory T cells(Tregs).Treg cells are a suppressive subset of CD4 positive T lymphocytes implicated in the prevention of GVHD after allogeneic HSCT.Here,we discuss the current findings of the relationship between the modification of gut microbiota and the GVHD-related immunity,which suggested that tactics with certain probiotics for the beneficial symbiosis in gut-immune axis might lead to the elevation of safety in the allogeneic HSCT.

Rh-incompatible hemolytic disease of the newborn in Hefei

BACKGROUND Anti-D antibody is not the common cause of Rh-isoimmunization in Chinese neonatal jaundice.Recent change in national population policy has followed by an increase in Rh-isoimmunization related hemolytic disease of the newborn(HDN).Unfortunately,regional status of Rh-HDN is unavailable.We hypothesize that Rh-HDN in our region is most commonly due to anti-E antibody.AIM To investigate the prevalence of hemolytic disease of the newborn due to Rhisoimmunization in Hefei City.METHODS Retrospective review of data obtained from Children’s Hospital of Anhui and Hefei Blood Center between January 2017 and June 2019.Status of minor blood group antibody was studied in the corresponding mothers.RESULTS Totally 4138 newborns with HDN admitted during the study period and 116(2.8%)received blood exchange transfusion(BET).Eighteen newborns(0.43%)with proven Rh-incompatible HDN were identified.All were not the first-born baby.Thirteen mothers were RhD(+)(72%)and five were RhD(-).The distribution of Rh-related antibodies in mothers was ten anti-E(55%),five anti-D(27%),and for one anti-C,anti-c,and anti-E/c(6%)each.Thirteen(72.2%)were qualified for BET,relative risk for BET was 28.9 as compared to other types of HDN,but only 10 received due to parenteral refusal.All(100%)RhD related HDN received BET which is not significantly different from RhE related HDN(81.8%).CONCLUSION As expected,all Rh-incompatible HDN newborns were not the first-born.Contrary to the Caucasian population,anti-D induced HDN is not the most common etiology.In our region,anti-E(11/18,61%)is the most common cause of Rh-HDN.

Crohn's disease in adults: Observations in a multiracial Asian population

AIM： To determine the demography and clinical presentation of CD and secondly to determine any differences in the prevalence between the different ethnic groups in a multiracial Asian population. METHODS： Patients with CD who were seen in 2001- 2003 in the University of Malaya Medical Centre （UMMC） were enrolled in this study. Prevalence of disease was calculated for the group as a whole and by race with hospital admissions per ethnic group as the denominator. RESULTS： Thirty-four patients were diagnosed to have CD. Basic demographic data of patients; male：female 17：17; mean age 29.1 years （±13.5 years）; ethnic group： Malays 5 （14.7%）, Chinese 12 （35.3%） and Indians 17 （50%）. Twenty-six （76.5%） were diagnosed under the age of 40 and 8 （23.5%） were diagnosed over the age of 40. Location of the disease was as follows： ileocolonic 13 （38.2%）, terminal ileum only 9 （26.5%）, colon only 8 （23.5%）, and upper gastrointestinal 4 （11.8%）. Sixteen （47.1%） had penetrating disease, 9 （26.5%） had stricturing disease and 9 （26.5%） had nonpenetrating and non-stricturing disease. The hospital admission prevalence of CD was 26.0 overall, Indians 52.6, Chinese 6.9, and Malays 9.3 per 10^5 admissions per ethnic group. The difference between Indians and Malays： [OR 5.67 （1.97, 17.53）P〈 0.001] was statistically significant but not between the Indians and the Chinese [OR 1.95 （0.89, 4.35） P= 0.700]. The difference between the Chinese and the Malays was also not statistically significant. [OR 2.90 （0.95, 9.42）P= 0.063]. CONCLUSION： The clinical presentation of CD is similar to the Western experience. Although the overall prevalence is low, there appears to be a clear racial predominance among the Indians.

Study on the action and mechanism of humic acids in Kaschin-Beck disease

Humic acids, especially FA in fractions, contain more oxygen functional groups. In this experiment, on the basis of confirming the action of humic acids on KBD, what was studied is the biological effects of one of main oxygen functional groups, hydroxy group (-OH). The results indicate that inducing pathologic process of KBD, obviously decrease the GSH-Px activity and induce peroxidation membrane injury of tissue. The SOD activity increase in the tissues caused by oxygen functional groups showed that enhancing of free radical reaction should not be neglected.

Crohn's disease in one mixed-race population in Brazil

AIM： To evaluate the classification and severity of Crohn＇s disease in different racial groups. METHODS： Patients with Crohn＇s disease from the outpatient clinic of the University Hospital Prof. Edgard Santos were enrolled in the study. This hospital is a reference centre for inflammatory bowel disease. Race was determined using self-identification. The Vienna＇s classification was applied for all subjects. The severity of Crohn＇s disease was determined according to the number of surgical procedures, hospital admissions in the last year and treatment with steroids and immunosuppressors. Statistical analysis was calculated using t test for means,χ^2 or F for proportions. A P value 〈 0.05 was considered to be significant. RESULTS： Sixty-five patients were enrolled. Non-white patients were more frequently diagnosed with Crohn＇s disease in the age less than 40 years than white patients. The behaviour of disease was similar in both groups with a high frequency of the penetrating form. There was a tendency for non-white patients to have a greater frequency of hospital admissions in the last year compared to white subjects. Non-whites also had a higher rate of colonic and upper gastrointestinal involvement, and were also more frequently on treatment with immunossupressors than white patients although this difference was not statistically significant. CONCLUSION： Non-white patients with Crohn＇s disease had an earlier diagnosis and appeared to have had a more severe disease Dresentation than white patients.

XRCC1 Arg194Trp Polymorphism and Risk of Chronic Obstructive Pulmonary Disease

The DNA damage, caused by cigarette smoking, can cause airway cell apoptosis and death, which may be associated with the development of chronic obstructive pulmonary disease （COPD）. However, just 20%-30% smokers develop COPD, which suggests that different degrees of DNA repair cause different outcomes in smokers. X-ray repair cross-complementing group 1 （XRCC 1）, a base excision repair protein, has multiple roles in repairing ROS-mediated, basal DNA damage and single-strand DNA breaks. The present study investigated the association between polymorphism in XRCC1 （Arg399Gln） and susceptibility of COPD. A total of 201 COPD cases and 309 controls were recruited and frequency-matched on age and sex. XRCC1 genotype was determined by PCR-restriction fragment length polymorphism analysis. Overall, compared with those with the XRCC1 Arg/Arg genotype, the risk for COPD had no significant difference among individuals with Trp/Trp genotype. However, after stratifying by smoking status, in former smokers, compared with those with the XRCC1 Arg/Arg genotype, the risk for COPD was significantly reduced among individuals with Trp/Trp genotype （adjusted OR=0.22, 95% CI 0.06-0.85, P=0.028）; after stratifying by smoking exposure, in light smokers, compared with those with the XRCC1 Arg/Arg genotype, the risk for COPD was significantly reduced among individuals with Arg/Trp genotype and Trp/Trp genotype （adjusted OR=0.39, 95% CI 0.16=0.94, P=0.036; 0.24, 95% CI 0.07-0.79, P=0.019, respectively）. In conclusion, XRCC1 Arg194Trp genotype is associated with a reduced risk of developing COPD among former and light smokers.

The Spread of Infectious Disease on Network Using Neutrosophic Algebraic Structure

Network theory and its associated techniques has tremendous impact in various discipline and research, from computer, engineering, architecture, humanities, social science to system biology. However in recent years epidemiology can be said to utilizes these potentials of network theory more than any other discipline. Graph which has been considered as the processor in network theory has a close relationship with epidemiology that dated as far back as early 1900 [1]. This is because the earliest models of infectious disease transfer were in a form of compartment which defines a graph even though adequate knowledge of mathematical computation and mechanistic behavior is scarce. This paper introduces a new type of disease propagation on network utilizing the potentials of neutrosophic algebraic group structures and graph theory.

Inflammatory bowel disease in adolescents:What problems does it pose?

Adolescents with inflammatory bowel disease face daily and long-term challenges that may be difficult for teenagers to manage. The developmental and psychosocial changes unique to this age group include becoming more autonomous and being more vulnerable to peer influence. These changes may lead to problems in medical management such as poor medication adherence and risky behavior. Being aware of these issues will help the medical team provide anticipatory guidance to address these concerns.

Oxidative alterations in sickle cell disease: Possible involvement in disease pathogenesis

Sickle cell disease(SCD) is the first molecular disease in the literature. Although the structural alteration and dysfunction of the sickle hemoglobin(HbS) are well understood, the many factors modifying the clinical signs and symptoms of the disease are under investigation. Besides having an abnormal electrophoretic mobility and solubility, HbS is unstable. The autooxidation rate of the abnormal HbS has been reported to be almost two times of the normal. There are two more components of the oxidative damage in SCD: Free radical induced oxidative damage during vaso-occlusion induced ischemia-reperfusion injury and decreased antioxidant capacity in the erythrocyte and in the circulation. We will discuss the effects of oxidative alterations in the erythrocyte and in the plasma of SCD patients in this review.

“With This Disease, You Take Whatever Chances There Are”—A Study on Socio-Cultural and Psychological Aspects of Experiments Regarding Huntington’s Disease

Although relatively rare, Huntington’s disease (HD) has fatal consequences. There is no cure for the disease, which leads to an early death. Worldwide, scientists are trying to develop therapeutic methods that could cure the disease, including new molecular gene therapeutic methods. At Lund University, research on HD is now about to step from animal models to trials with humans. The project is special in its design since it involves both medical studies and socio-cultural and psychological research to explore and meet the many challenges that experimental trials with HD patients give rise to. The aim of the present study was to investigate the viewpoints of individuals affected by HD on the issues of participation and exerting influence if taking part in a medical study on gene therapy that has not previously been tested on humans. A total of 16 participants, recruited through the national association for HD and through the neurological clinic at Lund University in Sweden, took part in a focus group or in a survey study. A thematic analysis, to explore the transcribed text from the focus groups as well as from the written mail responses, was conducted by means of Nvivo, a program for qualitative data analysis. Results showed three main themes expressing reasons for participation: participation as a last resort, as an activity of hope, and as a way to take responsibility for the development of a cure that will benefit future generations. The responses relating to the question about affected individuals’ view of exerting influence resulted in two themes. The first theme was having a voice when researchers design experiments, which may give a sense of receiving respect. The second was that influence is an essential part of the information process before agreeing to take part in an experimental trail.

Non-alcoholic fatty liver disease:Is surgery the best current option and can novel endoscopy play a role in the future?

alcohol as the leading cause of cirrhosis in the Western world.There remains to be a licensed pharmacological treatment for NAFLD.Weight loss is advised for all patients with NAFLD.Many patients however,struggle to lose the recommended weight with lifestyle modification alone.Many drugs have either failed to show significant improvement of steatosis or are poorly tolerated.Bariatric surgery has been shown to reduce liver steatosis and regress liver fibrosis.The pathophysiology is not fully understood,however recent evidence has pointed towards changes in the gut microbiome following surgery.Novel endoscopic treatment options provide a minimally invasive alternative for weight loss.Randomised controlled trials are now required for further clarification.

DRG支付方式下公立医院特殊病例住院费用影响因素分析

目的:分析DRG支付方式下,包括高倍率病例和低倍率病例在内的特殊病例费用特征及其影响因素,为降低医疗费用、减轻患者负担和完善DRG支付方式改革提供参考。方法:选取某三甲综合医院2022年全年所有特殊病例的病案首页数据,采用描述性分析和单因素分析对特殊病例的影响因素进行分析,并通过结构方程模型分析各影响因素间的作用路径和影响程度。结果:纳入高倍率病例1281例(占总病例2.78%),其中治疗费用花费最多(占16.29%),费用最少的是诊察费(占0.79%);低倍率病例3266例(占7.09%),其中手术费用花费最多(占31.51%),费用最少的是诊疗费(占1.61%)。性别、年龄、住院天数、科室类别、医保付费方式、并发症均是特殊病例住院费用的影响因素(P<0.05)。结构方程模型结果显示,科室类别对费用的影响最大,性别对费用的影响最小。结论:调整医疗费用结构,缩短患者的住院天数,合理使用DRG支付方式,从而降低医疗费用、提高诊疗效率,实现总体控费目标。

惠民保可持续发展研究

在多层次医疗保障体系建设中,惠民保是连接基本医疗保险与商业健康保险的中间层,是化解重大疾病风险、推进共同富裕的一项保障。本文探讨惠民保在多层次医疗保障体系中的地位,分析其参保、赔付以及产品现状,总结惠民保面临参保率不足、参保人群结构不良、赔付率不稳定且赔付不均等问题。基于此,本文提出实行基于DRG/DIP按病组支付的惠民保发展模式,旨在不影响相关主体利益的基础上改善参保率,优化参保结构,增强参保人获得感,从而吸引健康人群投保,提升制度普惠性和可持续性,为完善多层次医疗保障体系建设做出贡献。

基于决策树模型HC25病组DRGs细分组及住院费用的影响因素研究

目的构建基于决策树模型HC25病组患者DRGs细分组的研究及住院费用的影响因素。方法收集西安交通大学第一附属医院2020年1月至2022年6月依据CHS-DRG分组方案进入HC25(胆囊切除术,不伴并发症或合并症)病组患者的病案首页数据(n=3844),通过单因素和多因素分析了解影响住院费用的主要因素,通过建立决策树模型进行病例组合,分析分组效果及不同分组的费用标准。结果正态性检验结果显示:住院费用呈偏态分布(χ2=0.197,P<0.001);单因素方差分析结果显示:住院费用在不同年龄、性别、手术方式、患者来源、医疗付费方式、入院病情危重情况、术前时间、住院时间、是否有再住院计划之间,差异有统计学意义(P均<0.05);多重线性逐步回归分析结果显示,影响住院费用显著性差异的因素从大到小依次为:住院时间、手术方式、入院病情危重情况、性别、术前时间、患者来源、再住院计划(P均<0.05);采用CHAID共生成了7个DRGs分组,第一层分类节点变量是手术方式,第二层是术前时间、住院时间,第三层是入院时病情危重情况;不同DRGs组合的住院费用比较,差异有统计学意义(χ2=2474.595,P<0.001),组合DRGs(1)的住院费用最高,权重最高;DRGs(7)的住院费用最低,权重最小;所有DRGs病组中超标费用患者共170例(4.42%),各组超标费用比例均<10%。结论基于决策树模型对HC25病组的细分组效果合理有效,能较客观反映医疗资源消耗水平。