The Correlation of Hospital Operational Efficiency and Average Length of Stay in China: A Study Based on Provincial Level Data

Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.

Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan------A comparison of lengths of hospital stay and medical payments among hospitals

Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.

Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

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.

Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement:Food for thought

BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.

预住院管理对缩短平均住院日的影响

湖南省某大型综合性三级公立医院作为省内首批预住院试点单位,率先在床位集约式统筹管理基础上探索预住院管理模式,通过简化预住院流程、实施精细化服务、打通专用检查通道、运用信息化手段实行预住院患者全流程管理等措施,保障预住院工作的开展。通过实践,外科病房平均住院日显著下降,以乳腺外科、耳鼻喉科为例,实施先后对比,平均住院日分别降低4.41、3.29 d。文章深入探讨了预住院管理模式对缩短平均住院日的影响,为国内大型医院在提升运营效率、缓解床位紧张等方面提供参考,为践行改善就医感受提升患者体验主题活动、提升患者诊前体验提供思路。

手术室利用效率和效益最大化的管理办法

收集并分析来自于北京大学第三医院手术室有关效率的数据和管理方法。在之前的7年中,北医三院的平均住院日逐年降低,由2000年的15.3天降低到2006年的10.43天。研究中发现手术室目前的高效率得益于周转时间的缩短和麻醉时间控制。同时分析部分标准手术时间,这有助于规划并高效使用手术室资源。然而,在手术室管理方面依然存在问题需要解决,包括手术室管理、科室之间的沟通和协调、新技术的开展与推广,这些问题的解决将提高手术室效率,有效缩短平均住院日并最大化医院的效益。由于手术室效率的提高来自于周转时间的缩短和麻醉时间控制,那么手术量的变动和手术时间的安排需要进行相应的调整。

医院合理缩短术前平均住院日的影响因素研究

手术病人术前住院日是平均住院日的一个重要组成部分,它从一个侧面反映了医院的医疗、护理、医技力量,衡量医院外科系统临床科室工作效率的重要指标,而且还能全面反映医院的经营管理水平。通过专家咨询、专题讨论、回顾性分析以及跟踪调查等方法就影响手术科室术前住院日的因素进行分析,认为等待手术和等待检查是目前制约医院术前平均住院日的主要因素。

非计划再手术对平均住院费用及平均住院日影响研究

以某综合性三甲医院2007—2008年全部住院手术患者为研究对象,通过分析非计划再手术病例,探讨非计划再手术病例的平均住院日和平均住院费用。共分析2007—2008年非计划再手术病例共432例,平均住院日42.83天,平均住院费用68 810元。非计划再手术延长了住院天数,增加了住院费用。

影响术前平均住院日的因素分析与管理对策

背景术前住院日直接影响医院床位资源利用,是衡量医院运营管理水平的重要标志。目的通过回顾一家大型三甲医院数据,全面探讨术前平均住院日的影响因素,为医院缩短术前平均住院日提供可参考的模式。方法通过HIS系统,提取某三甲综合性医院2019年1月1日-12月31日开展的61892例住院择期手术患者临床资料,分析影响术前平均住院日的主要因素。结果大型手术科室、主要手术间手术、大型设备检查、周五入院、临时取消手术等会延长术前住院日;开展日间手术可大幅缩短术前住院日。结论缩短术前住院日涉及管理的多个环节,通过综合施治,全院术前平均住院日有望从4.3 d下降至3.5 d以下。

手术室加快手术台周转率的管理方法

目的:对北京大学第三医院手术室2005-2011年共7年的年手术例数、每台日平均手术例数、平均住院日等指标进行分析对比,总结手术室为缩短平均住院日所实施的管理方法。方法:利用回顾性分析对相应指标进行分析、总结。结果:手术室通过流程重组、"无障碍手术安排"、人性化管理、"安全手术室"等管理方法提高了手术台周转率。结论:手术室加快手术台周转、提高工作效率对缩短平均住院日起到了非常重要的作用。

缩短手术科室平均住院日举措及成效

本文以上海某医院为研究对象,分析缩短手术科室平均住院日的举措;评估举措实施后对缩短手术科室平均住院日和术前平均住院日的成效;讨论缩短平均住院日的目的和意义;对大型综合型医院缩短平均住院日提高医疗率具有借鉴意义。

缩短平均住院日的制度性对策探讨

目的:通过173例某病种平均住院日影响因素的分析,力图探讨政府在控制平均住院日中应如何进一步完善其职能。方法:运用问卷调查法、内容分析法及多元回归分析查找影响平均住院日的最主要因素。结果:通过多元回归分析发现,术前等待时间、入院后检查结果回报时间、医师的诊疗技术水平是影响平均住院日的主要影响因素。结论:政府可以通过在公示医疗指标时增加术前平均住院日的公示,调整基本医疗保险关于日间手术费用报销的相关政策,完善医师职称晋升管理,来加强政府对平均住院日的有效控制,提高卫生资源的利用效率。

加强床位管理 提高医院运转效率

目的在确保医疗质量和安全的前提下,通过床位管理,缩短平均住院日。方法责任指标落实到床位;核心制度落实到床位;人才培养符合床位要求;医技及后勤保障到床位;监督考核落实到床位等。结果平均住院日下降了2.1天,床位服务效率提升,医院运转效率提高。结论以床位管理为抓手,可以缩短平均住院日,实现医院社会效益和经济效益双赢目标。

腹腔镜微创手术对普外科平均住院日影响的研究

目的:为了评价微创技术在普外科应用对缩短平均住院日及降低成本和医疗费用的作用。方法:回顾性分析我院普外科从2000年至20008年6月的住院患者病例数据。结果:2000～2008年6月我院普外科的平均住院日从15.01天下降为7.39天。腹腔镜胆囊切除平均住院日由7.41天降为3.10天,腹腔镜胆囊切除患者的费用由2005年的10736.79元下降为2008年6月的7426.13元。腹腔镜结直肠癌手术的平均住院日腹腔镜组较开腹组相比下降3.1天;手术的高危患者比率增加;腹腔镜组总并发症的发生率降低;同时腹腔镜组较开腹组的护理时间减少486分钟。结论:通过流程改造和新技术的广泛使用,缩短了平均住院日,降低了医疗费用。

新医改形势下平均住院日管理的实践与探讨

平均住院日是一个综合性的医院管理指标,缩短平均住院日能有效地提高医院的医疗管理效率。通过开展择日手术和日间病房、缩短医技检查及等待时间、实施临床路径等举措,合理、有效地缩短了患者的平均住院日。

住院患者转科对平均住院日及术前住院日的影响分析

分析了患者住院期间发生科室之间转科和科室内部病区间转诊对平均住院日及术前住院日的影响,提出了基于上述情况计算科室平均住院日、术前住院日时应注意的问题,并给出了在"军字一号"HIS系统中科室住院日的计算方法。

缩短平均住院日在提高医院运营率中的作用

平均住院日可全面反映出医院的日常工作效率、管理水平与工作质量,对平均住院日进行缩短,有利于患者单次住院费用的降低,还能够将病床周转率进一步提高,利于将卫生资源利用率提高,可使得医院经济效益有效提高,近些年来,我院着重于缩短平均住院日,提高医院的运营效率等。文章主要分析了平均住院日的概念、平均住院日的重要性、复杂性、对应措施等,旨在加强医院的运营效益,促进医院的可持续发展。

某军队大型综合医院全麻择期手术流程的干预研究

手术室是为病人提供手术及抢救的场所,是医院的重要核心技术部门。手术室的正常、高效、科学运行关系到了所有外科科室及与手术相关科室的整体效率。因此,针对目前手术科室术前等待时间过长,手术台次安排低效的情况,通过对某军队大型三级甲等医院24间手术室的全麻手术运行情况进行跟踪调查,运用专家咨询、调查问卷、头脑风暴等方法对手术运转流程进行分析并采取干预措施,破除制约手术科室的瓶颈,提高手术科室的效率。