24825份住院病历问题分析

为提高病历质量,强化管理措施,笔者随机抽查了某医院2003年11月至2006年10月住院病历24825份,甲级病案率为95.82％,对影响病历质量的因素进行了分析,并针对存在的问题提出了相应的对策。     

住院科室医疗质量环节评价子系统研究

目的：每月动脉评价住院科室医疗护理工作情况。促进医疗环节质量控制,提高医疗质量,方法;对医疗护理工作环节质量检查的评分,采用秩和比法计算,以环节指数动态显示各科室工作情况。结果：建立了环节评价系统,每月计算出各科室医疗检查、护理检查和环节指数,并反馈科室,促进医疗护理工作的改进。结论：该系统科学地评价了各临床科室的医疗护理工作质量。其系统的应用对提高医疗质量,确保医疗安全起到明显的促进作用。     

瑞金医院1997-1999年部分病种住院费用及医疗质量评价

通过对上海瑞金医院1997－1999年3年中34个病种2981份病案的住院费用进行分析，占各病种总费用比例较大的是药品；几乎所有的病种1999年的平均住院日低于1997年；有10个病种的治愈率达到100％，而其他病种也取得了较好的治疗效果。提示合理检查、合理治疗、合理用药及缩短平均住院日是控制住院费用上涨的有效途径。加强医院的全面质量保证体系，以低廉的价格为病人提供优质的服务。     

住院患者呼吸系统疾病死亡与环境风险因素分析

目的通过分析呼吸系统疾病在所有住院死亡疾病中的构成与顺位,探讨其与环境风险因素的关系。方法对766名因呼吸系统疾病死亡的患者进行统计、分析。结果在所有住院死亡的疾病中,呼吸系统疾病死亡患者最多。结论呼吸系统疾病的高病死率可能与环境风险因素密切相关。     

Using PROMIS Pain Interference Items to Improve Quality Measurement in Inpatient Rehabilitation Facilities

Objective

To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference items for use in a quality measure and to compare the resulting quality score, along with internal reliability and validity, to a similar item set in the Minimum Data Set Version 3.0 (MDS).

胆石病伴胆囊炎手术患者住院费用分析

收集浙北某县人民医院胆石病伴胆囊炎手术患者住院费用和病案资料,进行现状、单因素和多因素分析,了解胆石病伴胆囊炎手术患者住院费用状况,探讨住院费用的影响因素,为控制其住院费用增长提供科学依据。结果显示：年龄、结石部位、感染情况、住院天数、付款方式、出院状态对胆石病伴胆囊炎手术患者住院费用有影响。     

医院门诊业务收入和住院业务收入变动的因素分析

本文试用因素分析法将门诊业务收入分解为门诊人次和门诊人次平均费用两个因素,将住院业务收入分解为出院人次、出院者平均住院日和出院者平均人日费用三个因素。分别建立门诊业务收入两因素指数体系和住院业务收入三因素指数体系,剖析各个因素变动对总量指标变动的影响程度和方向,阐明总量指标和各个因素之间的经济数量关系。     

Identifying and Accommodating Statistical Outliers When Setting Prospective Payment Rates for Inpatient Rehabilitation Facilities

Objective. To demonstrate how a Bayesian outlier accommodation model identifies and accommodates statistical outlier hospitals when developing facility payment adjustments for Medicare's prospective payment system for inpatient rehabilitation care.
Data Sources/Study Setting. Administrative data on costs and facility characteristics of inpatient rehabilitation facilities (IRFs) for calendar years 1998 and 1999.
Study Design. Compare standard linear regression and the Bayesian outlier accommodation model for developing facility payment adjustors for a prospective payment system.
Data Collection. Variables describing facility average cost per case and facility characteristics were derived from several administrative data sources.
Principal Findings. Evidence was found of non-normality of regression errors in the data used to develop facility payment adjustments for the inpatient rehabilitation facilities prospective payment system (IRF PPS). The Bayesian outlier accommodation model is shown to be appropriate for these data, but the model is largely consistent with the standard linear regression used in the development of the IRF PPS payment adjustors.
Conclusions. The Bayesian outlier accommodation model is more robust to statistical outlier IRFs than standard linear regression for developing facility payment adjustments. It also allows for easy interpretation of model parameters, making it a viable policy alternative to standard regression in setting payment rates.     

Mango Consumption Is Associated with Improved Nutrient Intakes,Diet Quality,and Weight-Related Health Outcomes

As nutrient-dense fruits, mangoes are commonly consumed globally and are important sources of nutrients in the diet. Nonetheless, mangoes remain relatively under-consumed in the United States. The objective of the present analysis was to examine nutrient intakes, diet quality, and health outcomes using data from NHANES 2001–2018 in children and adult mango consumers (n = 291; adults n = 449) compared with mango non-consumers (children n = 28,257; adults n = 44,574). Daily energy and nutrient intakes were adjusted for a complex sample design of NHANES using appropriate weights. Mango consumption was not associated with daily energy intake, compared with non-consumption, in both children and adults. Children consuming mangoes had a significantly lower daily intake of added sugar, sodium, total fat, and a higher intake of dietary fiber, magnesium, potassium, total choline, vitamin C, and vitamin D, compared with non-consumers. In adults, mango consumers had significantly higher daily intakes of dietary fiber, magnesium, potassium, folate, vitamin A, vitamin C, and vitamin E and significantly lower intakes of added sugar and cholesterol, compared with non-consumers. Mango consumption was also associated with a better diet quality vs. mango non-consumers (p < 0.0001). Mango consumption in adolescents was associated with lower BMI z-scores, compared with non-consumption. In adults, BMI scores, waist circumference, and body weight were significantly lower only in male mango consumers when compared with mango non-consumers. The current results support that mango consumption is associated with improved nutrient intakes, diet quality, and certain health outcomes. Thus, dietary strategies that aim to increase mango consumption in the American population should be evaluated as part of future dietary guidance.     

To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol

Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.     

Potential Risk Factors for,and Clinical Implications of,Delirium during Inpatient Rehabilitation: A Matched Case-Control Study

ObjectivesTo investigate the association between a wide set of baseline characteristics (age, sex, rehabilitation discipline), functional scores [Functional Independence Measure (FIM), cumulative Illness Rating Scale (CIRS)], diseases, and administered drugs and incident delirium in rehabilitation inpatients and, furthermore, to assess clinical implications of developing delirium during rehabilitation.DesignMatched case-control study based on electronic health record data.Setting and participantsWe studied rehabilitation stays of inpatients admitted between January 1, 2015, and December 31, 2018, to ZURZACH Care, Rehaklinik Bad Zurzach, an inpatient rehabilitation clinic in Switzerland.MethodsWe conducted unconditional logistic regression analyses to estimate adjusted odds ratios (AORs) with 95% CIs of exposures that were recorded in ≥5 cases and controls.ResultsAmong a total of 10,503 rehabilitation stays, we identified 125 validated cases. Older age, undergoing neurologic rehabilitation, a low FIM, and a high CIRS were associated with an increased risk of incident delirium. Being diagnosed with a bacterial infection (AOR 2.62, 95% CI 1.06-6.49), a disorder of fluid, electrolyte, or acid-base balance (AOR 2.76, 95% CI 1.19-6.38), Parkinson's disease (AOR 5.68, 95% CI 2.54-12.68), and administration of antipsychotic drugs (AOR 8.06, 95% CI 4.26-15.22), antiparkinson drugs (AOR 2.86, 95% CI 1.42-5.77), drugs for constipation (AOR 2.11, 95% CI 1.25-3.58), heparins (AOR 2.04, 95% CI 1.29-3.24), or antidepressant drugs (AOR 1.88, 95% CI 1.14-3.10) during rehabilitation, or an increased anticholinergic burden (ACB ≥ 3) (AOR 2.59, 95% CI 1.41-4.73) were also associated with an increased risk of incident delirium.Conclusions and ImplicationsWe identified a set of factors associated with an increased risk of incident delirium during inpatient rehabilitation. Our findings contribute to detect patients at risk of delirium during inpatient rehabilitation.     

山西省慢性病患者住院服务利用现状及影响因素研究

目的 了解2013与2018年山西省慢性病患者住院服务利用差异及住院服务利用的影响因素,为完善慢性病管理政策提供依据。方法 利用2013、2018年山西省第五、六次卫生服务调查慢性病患者数据,运用stata 16.0进行统计检验,组间比较采用χ²检验或t检验、住院影响因素分析采用logistic回归,住院床日的影响因素分析采用负二项回归。结果 慢性病患者住院率由2013年的13.63%上升为2018年的18.77%;2013和2018年在县级医院进行住院治疗占比分别为53.88%和57.77%;过去一年需住院未住院原因主要是经济困难;第六次卫生服务调查的次均住院费用为10 266.97元,高于第五次调查的次均住院费用(6 933.91元);饮酒(OR=1.355,95%CI:1.279～1.436)和患慢性病数(OR=1.701,95%CI:1.435～2.017)是住院服务利用的危险因素(P<0.05)。城市(RR=0.833,95%CI:0.714～0.971)、体育锻炼(≥3次/周)(RR=0.884,95%CI:0.799～0.979)、体检(RR=...     

Pediatric Hospitalization Patterns for Selected Chronic Health Conditions Using Hospital Abstract Reporting System Data: Methods and Findings

Children with chronic health conditions require more health services than other children and are vulnerable to potential problems of access and appropriateness of care due to rapid changes in the health care system. Methods to measure hospitalization patterns of children for chronic health conditions, a measure of access and utilization, are not well-developed. The objective of this study is to identify hospitalization patterns of children with eight selected chronic health conditions, using hospital abstract reporting system data from Washington state for the ten year period 1987–1996. The methods illustrate an approach to using hospital discharge data for ongoing surveillance of children with special health care needs.A total of 525,113 discharges representing 394,460 individual children ages 0–19 were analyzed in this study. Population-based hospitalization rate per 100,000 population, average length of stay, and rate of multiple hospitalizations per 1000 discharges, were calculated for asthma, diabetes, cystic fibrosis, muscular dystrophy, cerebral palsy, chronic respiratory disease, spina bifida, and malignant neoplasms. The hospitalization rate of 3,019.4 per 100,000 population for all causes among children 0–19 reflected a significant decline since 1987. Mean LOS of 4.9 for all causes in 1996 represented a significant decline from 5.3 in 1987. The multiple hospitalization rate for all causes increased significantly from 250.5 per 1000 discharges in 1987 to 275.5 per 1000 discharges in 1996. Condition-specific comparisons indicated an increase in hospitalization rates for asthma, chronic respiratory disease, and neoplasms, although the LOS declined for diabetes and was unchanged for all other conditions. Multiple hospitalization rates for selected conditions examined in this study did not show an increase in the ten-year period, and for diabetes, showed a statistically significant decline.The refinements in the approach to using hospital discharge data in this study are important tools to be used for pediatric chronic disease surveillance. Further refinements should include adjustments for patient age and condition complexity, as well as stratification by payer and facility.     

健康教育对流浪精神分裂症患者康复的作用

目的探讨健康教育对流浪精神分裂症患者的影响,以促进救治工作的更好开展。方法选取住院患者共100例,分为干预组与对照组各50例,两组均接受精神科常规治疗和护理,干预组在此基础上实施健康教育和康复训练。分别在干预前、干预12周末、干预24周末采用简明精神病量表(BPRS)、自知力与治疗态度问卷(ITAQ)、日常生活能力量表(ADL)、服药依从性量表进行评定,比较分析两组的评分。结果干预后两组BPRS总分及各因子分均较干预前显著下降(P<0.01),干预后干预组在12周末总分和焦虑抑郁、缺乏活力、敌对猜疑三个因子分分别为53.14±6.73、9.31±3.55、10.53±4.07、6.53±2.55,均显著低于对照组的69.06±7.87、12.04±3.43、13.84±4.97、9.24±3.22(P<0.01),在思维障碍和激活性两个因子分没有显著性差异(P>0.05);干预后干预组ADL评分总分和各因子分在12周末、24周末均较干预前显著下降(P<0.01),而对照组没有显著性差异(P>0.05),干预后两组间比较,有显著性差异(P<0.01)。结论健康教育能明显提高流浪精神分裂症患者的社会功能和社会适应能力。     

Post-Acute Care in Inpatient Rehabilitation Facilities Between Traditional Medicare and Medicare Advantage Plans Before and During the COVID-19 Pandemic

ObjectivesCompare post-acute care (PAC) utilization and outcomes in inpatient rehabilitation facilities (IRF) between beneficiaries covered by Traditional Medicare (TM) and Medicare Advantage (MA) plans during the COVID-19 pandemic relative to the previous year.DesignThis multiyear cross-sectional study used Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF-PAI) data to assess PAC delivery from January 2019 to December 2020.Setting and ParticipantsInpatient rehabilitation for stroke, hip fracture, joint replacement, and cardiac and pulmonary conditions among Medicare beneficiaries 65 years or older.MethodsPatient-level multivariate regression models with difference-in-differences approach were used to compare TM and MA plans in length of stay (LOS), payment per episode, functional improvements, and discharge locations.ResultsA total of 271,188 patients were analyzed [women (57.1%), mean (SD) age 77.8 (0.06) years], among whom 138,277 were admitted for stroke, 68,488 hip fracture, 19,020 joint replacement, and 35,334 cardiac and 10,069 pulmonary conditions. Before the pandemic, MA beneficiaries had longer LOS (+0.22 days; 95% CI: 0.15–0.29), lower payment per episode (−$361.05; 95% CI: −573.38 to −148.72), more discharges to home with a home health agency (HHA) (48.9% vs 46.6%), and less to a skilled nursing facility (SNF) (15.7% vs 20.2%) than TM beneficiaries. During the pandemic, both plan types had shorter LOS (−0.68 day; 95% CI: 0.54–0.84), higher payment (+$798; 95% CI: 558–1036), increased discharges to home with an HHA (52.8% vs 46.6%), and decreased discharges to an SNF (14.5% vs 20.2%) than before. Differences between TM and MA beneficiaries in these outcomes became smaller and less significant. All results were adjusted for beneficiary and facility characteristics.Conclusions and ImplicationsAlthough the COVID-19 pandemic affected PAC delivery in IRF in the same directions for both TM and MA plans, the timing, time duration, and magnitude of the impacts were different across measures and admission conditions. Differences between the 2 plan types shrank and performance across all dimensions became more comparable over time.     

Rehabilitation medicine-Efficacy and effectiveness in the German health care system exemplified for persons with musculoskeletal diseases

This article summarizes studies published during the past 4 years from different areas of research considering the efficacy or effectiveness of medical rehabilitation for persons with musculoskeletal diseases (MSD) in Germany. Efficacy refers to data generated under experimental conditions in controlled studies of interventions including one or more components. Various aspects of efficacy were investigated in randomized controlled studies of multidisciplinary patient education programs, psychological interventions, rehabilitation measures adjusted to psychological or somatic risk profiles and workplace-related medical interventions. Effectiveness studies concerning rehabilitation are performed under routine conditions, i.e., the interventions under study are applied to populations/groups that are usually not or are less selected compared to efficacy studies. This type of study comprises comparisons between outpatient and inpatient settings and, considering a broad definition of effectiveness, non-comparative cohort studies, metaanalyses including long-term cohort studies, analyses from the pension insurance follow-up database and outcome benchmarking of rehabilitation centers. Cross-sectional studies of physicians’ and patients’ judgments of rehabilitation elucidate the issue of effectiveness from different perspectives, which may have a significant impact on the demand and application for medical rehabilitation. In several efficacy studies high levels of evidence have been demonstrated for different components of medical rehabilitation. Even though effectiveness studies frequently lack randomization or even control groups, they give some orientation. This is indispensable for decision makers as long as higher level evidence is not available under the conditions of the German legislation and social security system. Finally, priorities for future research in rehabilitation medicine are summarized.     

三甲综合医院康复院区的建设与运行实践

康复需求持续扩大与医院规模化发展的现实背景,催生了康复院区的建设。本文通过对陕西省某三甲综合医院康复院区的规划设计、运营管理、建设成效的回顾,探讨康复院区建设的实践经验,主要包括:搭建垂直架构,实行一院两区同质化管理;统一医疗管理标准;强化学科交叉服务;稳步优化人才队伍。