ObjectiveAs few studies have evaluated the policy effects of the Chinese simplified DRGs-PPS systematically, this research aims to assess its policy effects and to provide insight for other developing regions that are undergoing the same reform. MethodsThe history and major problems of the Chinese DRGs-PPS were analyzed qualitatively. Moreover, the efficiency (average hospitalization cost; length of stay, LOS) and equity of the simplified DRGs-PPS were examined at both macro and micro levels. ResultsAs of today, only 20 of the 32 provinces in mainland China had implemented the simplified DRGs. There were also huge differences in terms of the number and categories of diseases among the various provinces involved. Literature review showed that " lack of rationale in setting payment standards" , "limited diseases are included into the DRGs categories" and "lack of regulation to avoid ethical risks of health service providers" were the frequently cited problems. On the macro level, the national average medical cost had increased while the average LOS had been relatively stable from the year 2004 onwards, and simplified DRGs had been implemented widely since 2004 while discrepancies existed in various provinces. On the micro level, among the studies that focused on assessing hospitals with statistical test, 78% (11/14) of these studies revealed that hospitalization cost could be reduced and 60% (6/10) of them indicated that LOS could be reduced. ConclusionBy comparing the policy effects at both macro and micro levels, we conclude that the simplified DRGs are useful in controlling hospitalization cost but they fail to reduce LOS. Also much more still needs to be done in China to facilitate the transition from simplified DRGs to genuine DRGs.
目的 探讨经阴道B型超声（B超）在诊断早期宫外孕中的临床应用价值。 方法 回顾分析2011年5月－2012年3月应用阴道B超与腹部B超对78例宫外孕患者进行对比检查的临床资料并回顾性分析，评价两种检查方法的临床效果。 结果 78例宫外孕患者，应用经阴道B超检查诊断准确率为97.44%，应用腹部B超准确率为61.54%，差异具有统计学意义（χ2=6.472，P＜0.05）；经阴道B超检查诊断附件包块、宫内假孕囊、心血管搏动、胚芽、盆腔积液的检出率明显高于经腹部B 超检查的检出率（P＜0.05）。 结论 阴道B超具有操作简单、快速、无副作用、无需充盈膀胱等优点，在宫外孕的早期诊断中具有绝对的优越性，为临床提供了更方便、更快捷的诊断手段，减轻了患者痛苦，提高了诊断的准确率，值得临床广泛推广和应用。
ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
ObjectiveTo explore the clinical effectiveness of two kinds of treatment methods to nurse wound after tracheotomy. MethodsWe collected 108 cases and randomly divided them into two groups between March 2012 and May 2013. The experimental group (n=52) received tracheotomy care with PermaFoam dressing, while the control group (n=56) was treated with traditional sterile absorbent gauze. We analyzed the differences in terms of infection of wound, errhysis and frequency of dressing changes between the two groups. ResultsThe experimental group had a lower rate of wound infection than the control group (P<0.05). Moreover, the experimental group was superior to the control group in the total number of dressing changes, wound redness and oozing (P<0.05). ConclusionPermaFoam dressing can reduce wound complications and frequency of dressing changes effectively. It is easy to operate, and can reduce the workload of clinical nursing, and deserves clinical application.
ObjectiveTo evaluate the clinical efficacy of medical absorbent pads in the treatment of wouds. MethodsA total of 200 patients treated in the Wound Treating Center of a first-class hospital between November 2014 and August 2015 were randomly divided into trial group and control group with 100 patients in each. Patients in the trial group received medical absorbent pads, while patients in the control group received the treatment of Zetuvitò E. All patients received four times of treatment. Then we used self-made observation record form to evaluate such indexes as water absorption and compliance of the dressing, patients' pain and secondary trauma scores and the score of skins around the wounds. ResultsThere was no significant difference in water absorption property and compliance between the two groups (P>0.05). But the score of visual analogue scale was lower in the trial group than that in the control group at the fourth dressing changing (P<0.05), and the score of secondary trauma was also lower in the trial group than that in the control group at the third and fourth dressing changing (P<0.05). ConclusionThe medical absorbent pads used in the trial group can relieve pain and promote wound healing. It can be used for the treatment of wounds, and also has better effectiveness and safety.
Methodological quality and transferability will be important issues for the credibility and usefulness of both published studies and administrative methods for evaluating the socio-economic value of marketed medicines in China. This paper critically examines factors commonly contributing to, or inhibiting, the quality and transferability of socio-economic evidence of the value of medicines, with specific reference to the Chinese community. It discusses appropriate approaches to design, performance, and reporting of published economic evaluation studies, as well as guides on assessment of quality of economic evaluations and recommends two internationally established methods that may be suitable for training in this setting.
ObjectiveTo systematically review the effects of the promotion of appropriate health technology in China and provide reference for improving the promotion of appropriate health technologies. MethodsDatabases including CBM, VIP, CNKI and WanFang Data were searched for studies about the appropriate health technology in China from inception to August 2014. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies by the evaluation criteria for descriptive studies of MAStARI, an assessment tool developed by JBI Evidence-Based Health Care Center. And then, qualitative descriptive analysis method was used to comprehensively analyze the data from four aspects: medical institutions, regulators, technology promotion medical staff and patients. ResultsA total of 23 cross-sectional studies and one before-after study were included. The results of qualitative analysis showed that: 1) the technology utilization rate of appropriate health technology extension institutions was more than 70%, the number of outpatients of township and village organizations increased significantly than that of the county level institutions; 2) director of technology extension and managers of hospital were in favor of the promotion of appropriate technology for its good effectiveness, safety, lower medical costs, and skill improvement of medical staff; 3) medical staff mastered the appropriate health technology, they were willing to promote appropriate technology and spoke highly of it for its safety, feasibility and economic effect, and improved their level of technology; 4) in patients' opinion, the appropriate technology reduced the disease course and cost, they spoke highly of it for its acceptance, efficacy and safety. ConclusionCurrent evidence shows that the promotion of appropriate health technology has achieved good effects. The satisfaction of medical institutions, managers, health service staff and patient is high, but these research results are of poor quality, mostly subjective evaluation, lack of scientific, rational, objective and consistent evaluation criteria, which cannot be used as evaluation evidence for the promotion of appropriate health technology.