ObjectiveTo classify and analyze medical audit chargeback of a hospital and to propose management strategies. MethodsWe classified the project audit chargeback of a grade-three class-A comprehensive hospital in Chengdu from June to December 2013, and analyzed the underlying causes of the chargeback. ResultsThe total chargeback of the hospital from June to December 2013 was more than 30 000 items and the general amount involved was about 3 million yuan. The project number of recurring charges, excessive charges, unreasonable charges, anchored fees, inconsistent charges with doctors' advices, non-indications, disproportionate fees and charges over restriction accounts occupied respectively 42.99%, 39.71%, 9.15%, 5.73%, 0.35%, 0.17%, 1.44% and 0.46%; and the amount of money involved for those projects occupied respectively 8.84%, 52.55%, 14.44%, 10.70%, 2.54%, 1.15%, 8.91% and 0.88%. ConclusionThe reasons for project audit chargeback are complicated. By strengthening information technology, management of price and building negotiation mechanism with Medical Insurance and Pricing Management Institutes, we can reduce the amount of chargeback, protect the right of patients and enhance the efficient use of the health insurance fund, so that the hospital, medical insurance and patients can all get benefits.
ObjectiveTo explore effective evaluation tools as well as systems of medical service capability related to total payment control of medical insurance. MethodsCombining references and using the Delphi method, the evaluation indicators of total payment control of medical insurance were screened and identified. Then, based on analytic hierarchy process, a weight questionnaire was designed and weighted coefficients of all-level indicators were also calculated. ResultsWe proposed a mathematical model to evaluate medical service capability related to total payment control of medical insurance using three types of primary evaluation indicators and seventeen types of secondary evaluation indicators with their weighted coefficients. ConclusionThe establishment of the evaluation systems of medical service capability in medical institutions could objectively reflect medical service capability to some extent, and provide references on total payment control of medical insurance for medical insurance agencies.
ObjectiveTo investigate the influence and management of blood pressure on intraoperative cortex somatosensory evoked potential (CSEP) in the surgery of severe scoliosis. MethodsFrom June 2009 to March 2012, CSEP monitoring during surgery of severe scoliosis were performed on 43 patients, in whom 4 had abnormal CSEP while blood pressure decline. There were 2 males and 21 females. The average age was 16.1 years. The average preoperative Cobb angle was 96.1° (88.7-107.5°). Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. The arterial blood pressure (ABP) was used to evaluate the intraoperative blood pressure. ResultThe incidence rate of bilateral CSEP wave abnormalities after blood pressure decline was 9.3% in the surgery of severe scoliosis. One case of CSEP abnormality occurred during the installing of pedicle screws; two cases during the Smith-Petersen osteotomy, and one case during the bone graft after correction. With the ABP dropping to about 92/57 mm Hg (1 mm Hg=0.133 kPa), the amplitude decreased 80% in 24-33 minutes. After the ABP increased to 113/75 mm Hg by treatment, the index was backed up normally in 5-10 minutes. There was no neurological complication after surgery. ConclusionA high incidence rate and significantly decreased amplitude of CSEP abnormality after blood pressure decline in the surgery of severe scoliosis are found. Intraoperative stable blood pressure should be maintained for patients with severe scoliosis. When the amplitude of CSEP decreases followed with blood pressure decline, blood pressure should be actively corrected by treatment, so that the CSEP may get back to normal as soon as possible.
ObjectiveTo assess the effects of nursing grading management for nurses in emergency department. MethodsAll nurses of the employment system in Department of Emergency were classified into different groups in 2011. Based on the combination of the duties of nurses, technical requirements and nursing grading management, nurses of different levels were given the right tasks, so that nurses in the emergency department could make use of their special skills. ResultsAs the result of nursing grading management, the rates of satisfaction of patients and survival of critically-ill patients were increased, and the rates of pressure ulcer, nursing adverse events and wrong nursing documents were reduced. ConclusionNursing grading management not only saves nursing resources and improves nursing efficiency, but also ensures quality and safety of nursing.
ObjectiveTo compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer. MethodsThe clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time, blood loss, time to passage of flatus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4+, CD8+, IgG, IgA, IgM, and CRP were examined respectively by using flow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7. ResultsThe operative time was longer significantly in LA group than that in OO group(P < 0.05). The mean blood loss, the first flatus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P < 0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not significantly different in the two groups(P > 0.05). On the day 1 and 7 after operation, the CD3, CD4+, and CD8+ significantly decreased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM significantly decreased as compared with those preoperatively in two groups(P < 0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P < 0.05). On the day 1 and 7 after operation, CRP level significantly increased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). Those changes of above index were not significantly different between the LA group and OO group on the day 1 after operation(P > 0.05). All index recovered gradually in the two groups on the day 7 after operation and were better in LA group(P < 0.05, except IgA). ConclusionLaparoscopic radical gastrectomy for advanced gastric cancer resulted in a quicker clinical recovery and a lesser depression to the perioperative cellular and humoral immune function.