Objective To understand the changing patterns and characteristics of the number of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before, during, and in the post-epidemic period of the COVID-19 pandemic and the Association between acute respiratory infections and hospitalization of patients with AECOPD. Methods A retrospective analysis was conducted to count the patients hospitalized for AECOPD in the Department of Respiratory Medicine of the Third Affiliated Hospital of Chongqing Medical University from July 2017 to June 2024. The pattern of change in the number of AECOPD hospitalizations and the associations with patients with respiratory tract infections in outpatient emergency departments were analyzed. Results During the COVID-19 epidemic, the number of hospitalizations of patients with AECOPD did not increase compared with the pre-epidemic period. Instead, it significantly decreased, especially in the winter and spring peaks (P<0.05). The only exception was a peak AECOPD hospitalization in the summer of 2022. COPD inpatient mortality and non-medical discharge rates tended to increase during the epidemic compared with the pre-epidemic period. Analysis of the curve of change in the number of patients with respiratory infections in our outpatient emergency departments during the same period revealed a downward trend in the number of patients with respiratory infections during the epidemic and an explosive increase in the number of patients with respiratory infections in the post epidemic period, whose average monthly number was more than twice as high as that during the epidemic. Correlation analysis of the number of patients with respiratory infections between AECOPD hospitalizations and outpatient emergency departments showed that there was a good correlation between the two in the pre-epidemic and post-epidemic periods, and the correlation between the two in the post-epidemic period was more significant in particular (r=0.84-0.91, P<0.001).In contrast, there was no significant correlation in 2021 and 2022 during the epidemic (r=0.24 and 0.50, P>0.05 ). The most common respiratory infection pathogens among AECOPD hospitalized patients during the post-epidemic period were influenza virus, COVID-19 virus, and human rhinovirus, respectively. Conclusions The pandemic period of COVID-19 infection did not show an increase in the number of AECOPD hospitalizations but rather a trend towards fewer hospitalizations. Respiratory infections were strongly associated with the number of AECOPD hospitalizations in the pre- and post-pandemic periods, while the correlation between the two was poorer during the pandemic period. Influenza virus was the most important respiratory infection pathogen for AECOPD during the post-epidemic period.
Objective To investigate the association between costs of hospitalized patients with diabetes mellitus and their complications in the West China Hospital of Sichuan University, so as to provide baseline data for further research. Methods We extracted the hospitalization case data of hospitalized patients with diabetes mellitus who were discharged from the department of endocrinology and metabolism, or discharged after being transferred to other departments for treatment from January 2011 to December 2012, using the hospital information system (HIS) of the West China Hospital of Sichuan University. The data included baseline of hospital patients, discharge diagnosis, hospitalization costs, and if their medical insurance had been registered in hospital. Then, we classified the diseases according to ICD-10 based on discharge diagnosis, coped the data using Excel 2010 software, and conducted statistical analysis using SPSS 13.0. Results a) In 2011, acute and chronic diabetes complication in diabetes inpatients were 11.9% (166/1 396) and 67.1% (930/1 396), respectively. Most of them had peripheral neuropathy and peripheral vascular disease. b) The most frequently-occurred complications were hypertension, followed by dyslipidemia, and osteoporosis. c) The median hospital stay was 13 days (7 to 9 days), and the median total cost of hospital/person-time was 6 578.88 yuan (4 186.93 to 10 953.89 yuan). d) The total cost and duration of hospitalization increased along with the increasing number of the chronic complications of diabetes. e) The diabetic foot patients were 255 person-times, the median duration of hospitalization was 18 days (13 to 29 days), and the median total cost of hospital/person-time was 16 672.19 yuan (10 903.93 to 28 530.37 yuan). Diabetes patients with foot complication had higher total costs and longer duration of hospitalization than those without foot complication. Conclusion Diabetes mellitus is one of the most important diseases in the department of endocrinology and metabolism, which is heavy disease burden. The costs of hospitalization and chronic complications are closely associated. Among these complications, diabetic foot is the heaviest disease burden.
Objective To investigate financial burden of in-patients with hypothalamus-pituitary-adrenal gland/gonad diseases in the West China Hospital of Sichuan University, 2011, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: in 2011, 352 person-times of in-patients with hypothalamus-pituitary-adrenal gland/gonad disease as first diagnosis were hospitalized in the department of endocrinology and metabolism, of which, 139 were male and 213 were female, with mean age of 42.9±15.0 years; and b) median hospital stay was 11 days, the average cost of hospital stay for each patient was RMB 4 361.09 yuan, most of which was for lab tests, examination, and biomedicine cost. Conclusion Hypothalamus-pituitary-adrenal gland/gonad diseases are an important health problem in the department of endocrinology and metabolism in a Triple-A Hospital. Most of hospitalization costs are for lab tests, examination, and biomedicine cost.
Objective To Provide statistical references for disease-based payment reform with Diagnosis Related Groups (DRGs). Methods Based on 1 969 stroke inpatients from two hospitals in Chongqing city, we used classification and regression trees (CART) of decision tree to establish classification regulations of the case-mix model for stroke inpatients, and multivariate statistical model to evaluate whether the case-mix could provide a satisfactory prediction to costs for stroke inpatients in comparison with the foreign model. Results ① The classification nodes of our model were surgical procedure, nursing care degree, and hospital infection respectively by which 1 969 stroke inpatients were divided into 5 groups. The classification nodes in foreign model were surgical procedure, age≥50 years, and whether patients would refer to other institutions after leaving the hospitals by which 1 969 stroke inpatients were also classified into 5 groups. ② For medical institutions and the third payers, we found that the data from our model could explain 80.46% of the total costs and 16.58% for individual inpatient, which were higher than that of foreign model (76.87% for medical institutions and the third payers, 9.13% for individuals ). Conclusions Compared with foreign model, our model is more suitable for the situation in China. The study is only based on 1 969 stroke inpatients from south west part of China, so the conclusion needs further studies to confirm.
ObjectiveIn light of the comprehensively implemented reform of medical insurance payments, this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine (TCM) and Western medicine hospitals, to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load. MethodsFrom January 2014 to December 2020, we gathered data including 9 900 individual medical records of woman-related malignant tumors (WMT) from all 23 public hospitals in a district of Shanghai. We developed an interrupted time-series analysis model based on the above two interventions, to compare the inpatient average per-time expenses between different hospitals and different groups. ResultsThe average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention, and increased again during the pandemic. In TCM hospitals, the expenses continued to increase and fluctuated after the pandemic. ConclusionThe policy intervention has achieved a good effect on controlling the cost of Western hospitals, rather than the significant increase in TCM hospitals. Meanwhile, the COVID-19 pandemic has had a significant impact on hospitalization expenses. It’s urgent to develop a payment model that fits the development and characteristics of TCM, to control the unreasonable growth of expenses. Moreover, the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.
ObjectivesTo investigate risk factors for unplanned readmission in ischemic stroke patients within 31 days by using random forest algorithm.MethodsThe record of readmission patients with ischemic stroke within 31 days from 24 hospitals in Beijing between between 2015 and 2016 were collected. Patients were divided into two groups according to the occurrence of readmission within 31 days or not. Chi-squared or Mann-Whitney U test was used to select variables into the random forest algorithm. The precision coefficient and the Gini coefficient were used to comprehensively assess the importance of all variables, and select the more important variables and use the margind effect to assess relative risk of different levels.ResultsA total of 3 473 patients were included, among them 960 (27.64%) were readmitted within 31 days after stroke hospitalization. Based on the result of random forest, the most important variables affecting the risk of unplanned readmission within 31 days included the length of hospital stay, age, medical expense payment, rank of hospital, and occupation. When hospitalization was within 1 month, 10-day-hospitalization-stay patients had the lowest risk of rehospitalization; the younger the patients was, the higher the risk of readmission was. For ranks of hospital, patients from tertiary hospital had higher risk than secondary hospital. Furthermore, patients whose medical expenses were paid by free medical service and whose occupations were managers or staffs had higher risk of readmission within 31 days.ConclusionsThe unplanned readmission risk within 31 days of discharged ischemic stroke patients was connected not only with disease, but also with personal social and economic factors. Thus, more attention should be paid to both the medical process and the personal and family factors of stroke patients.
Objective To identify the chief factors influencing the hospitalization expenses in fracture patients with health insurance so as to provide information for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods A total of 113 fracture patients with medical insurance in a hospital of a certain city from September 2006 to April 2007 were included and statistical analysis was performed by using multinomial linear regression analysis. Results The major factors influencing the hospitalization expenses in fracture patients with health insurance included the proportion of material fees and drug fees, length of stay, performance of operations and blood transfusion and etc. Conclusion Lowering the proportion of material fees and drug fees reasonably, reducing the length of hospital stay and avoiding operations and blood transfusion were the key to the control of hospitalization expenses for fracture. It is imperative to speed up and deepen the reform in medical insurance system, formulate scientific diagnostic and treatment routines and clinical pathways as well as expense standards, and try out the payment on certain single disease such as fracture.
Abstract Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center (SqC) in Gaoyou City of Jiangsu Province in 2010, so as to provide the baseline data of disease burden for further study. Methods The inpatient records of SqC in 2010 were collected. The first discharge diagnoses were classified according to the International Classification of Disease 10 (ICD-10). The general information of the inpatients, discharge diagnosis, hospitalization expenses, disease category, age, gender, and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients was 1036 in 2010, and the gender ratio was about 1.0 (50.7% vs. 49.3%); b) The disease spectrum included 17 categories. The cumulative percents of the top 5 systematic diseases were 81.2%, including the respiratory, digestive, neoplasm, circulatory diseases, and injury, poisoning amp; external causes; c) The top 15 diseases were pneumonia, fracture, malignant neoplasm, benign neoplasm, acute bronchitis, cerebral infarction, hypertension, acute appendicitis, emphysema, cholecystolithias accompanied with cholecystitis, inguinal hernia, coronary heart disease, diabetes mellitus, chronic bronchitis and superficial injury; d) The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5; e) The number of chronic diseases significantly increased with age, especially after the age of 35 years old, and reached the peak at the age over 65 years old; while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old. The average length of stay, the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones (13.8 days vs. 9.9 days, ? 3 082 vs. ? 2 615; ? 417 vs. ? 371, respectively); f)The length of stay and total hospitalization per capita were quite higher than the other township health centers (11.6 days vs. 5.2 days, ? 3 001.4 vs. ? 1 004.6); and g) Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses. Among the total reimbursement, the payment from New Cooperative Medical Scheme (NCMS) accounted for over 99%, while that from Medical Aid Scheme only accounted for less than 2%. Conclusion a) The top 3 systematic diseases of SqC are seen in respiratory system, digestive system and neoplasm. The acute diseases are mainly pneumonia and fracture; b) The number of acute or chronic diseases increases significantly with age, especially after 35 years old. Both adolescents and the aged suffer from the heaviest burden of diseases; c) The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers; and d) NCMS is the major source of reimbursement. However, the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy. Thus the policy of NCMS needs to be adjusted step by step in future.
ObjectiveTo investigate constitution and financial burden of disease in the West China Hospital of Sichuan University during 2011-2012. MethodsThe data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital from January 2011 to April 2012) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, discharge diagnosis, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on each diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Resultsa) During 2011-2012, in the department of endocrinology and metabolism, the top five commonly-seen diseases of in-patients were:diabetes, followed by hypothalamic-pituitary-adrenal/gonadal disease, diseases other than endocrine disorders, thyroid disease, and metabolic bone disease. b) The diseases of the top five average hospital stay included:diabetes, followed by malnutrition, metabolic bone disease, diseases other than endocrine disorders, and hypothalamic-pituitary-adrenal/gonadal disease. c) The diseases of the top five total costs of included:diabetes, followed by metabolic bone disease, diseases other than endocrine disorders, malnutrition, and other nutrients deficiency. ConclusionDiabetes and its complications are the major disease as well as the major cause of the burden of disease in the in-patient department of endocrinology and metabolism of the West China Hospital of Sichuan University.
Objective To investigate the disease constitution and hospitalization cost in Yong’an Central Township Health Center (YaC) in Shuangliu County of Sichuan Province from 2008 to 2010, so as to provide baseline data for further research. Methods Questionnaire and focus interview were carried out; case records and cost information of YaC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients were 4 236, 4 335 and 4 844 in 2008, 2009 and 2010, respectively. Females were more than males (56.99% vs. 42.96%, 55.59% vs. 44.1%, 54.36% vs. 45.62%), and their disease spectrum included 20 categories, which accounted for 95% of disease classes of ICD-10; b) The inpatients suffering from top three systematic diseases accounted for 62.74% to 72.31%, which included the respiratory, digestive, urinary tract and urogenital systematic disease; c) The top 15 single diseases were upper respiratory infection, acute bronchitis, pulmonary infection, acute gastroenteritis, fracture, acute appendicitis, chronic bronchitis, calculi in urinary system, cerebral vascular insufficiency, lumbar vertebra disease, acute gastritis, superficial injury, chronic gastritis, hypertension, and cholecytolithiasis or cholecystitis; d) The number of inpatients in the group of over 15-24 ages with chronic diseases increased with age and females were more than males. The acute disease burden of inpatients in 0-4 age group was the heaviest, who only suffered from acute diseases and males were more than females. The inpatients in 25-54 age group suffered from more acute diseases than chronic diseases and females were more than males; and e) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (1 564.45 yuan vs. 1 104.11 yuan) and those of either Xintian Central Township Health Center (1 311.81 yuan) or Gaozha Central Township Health Center (1 002.99 yuan). Conclusion a) In recent three years, the main systematic diseases that inpatients suffer are digestive, respiratory, and urinary tract and urogenital system diseases; the acute diseases are more than the chronic; the acute diseases mainly include infection and injury; b) During the past three years, the top 15 diseases have been stable and the same diseases include upper respiratory infection, pulmonary infection, acute bronchitis, acute appendicitis, acute gastritis, acute gastroenteritis, fracture, chronic gastritis, chronic bronchitis, and calculi in urinary system; c) It should be paid attention to the inpatients with chronic diseases in over 15-24 age group and the inpatients with acute diseases in 0-4 age group; and d) The inpatients’ average costs of top 15 diseases in 2010 were higher than those of either XtC or GzC, and consideration on rationality of the hospitalization cost should be paid attention to.