Objective To explore the medical insurance quota payment of dialysis treatment for outpatients with end-stage renal disease in Chengdu from following aspects, evaluation indexes and reasonable amount, so as to provide scientific basis for the payment of single disease. Methods A questionnaire survey was conducted to collect the cost information of patients, and to formulate the assignment of evaluation indexes according to the therapeutic principles and statistical results; Delphi method was adopted to determine the assignment and the standard of quota payment. Results A total of 17 dialysis organizations approved by Chengdu municipal medical insurance were involved in this study. Of 700 questionnaires distributed, 686 were retrieved. After excluding 26 questionnaires for incomplete filling and incorrect treatment information, a total of 660 questionnaires were included actually, accounted for 94.28% of all informants. The results of survey showed that, the hemodialysis treatment rate accounted for 84% (555/660) of all informants, while the peritoneal dialysis treatment rate accounted for 16% (105/660). By assessing the project assignment of outpatient dialysis treatment, the minimum annual payment of hemodialysis was RMB 118 242.75 yuan, while that of peritoneal dialysis was RMB 96 498.00 yuan. Conclusion The quota payment of outpatient dialysis shows b evidence after adopting the treatment project assignment. The grading quota payment of outpatient dialysis enables the medical insurance fund to be more reasonably used.
Objective To accurately predict the outpatient and emergency visits of a district-level public hospital based on autoregressive integrated moving average (ARIMA) model, providing important basis for hospital budget planning and operational decisions. Methods The monthly outpatient and emergency visits of a public hospital in Shuangliu District, Chengdu City from January 2012 to November 2023 were collected, and R 4.3.1 software was used to establish an ARIMA model based on the data from January 2012 to December 2022. The outpatient and emergency visits from January to November 2023 were predicted and validated. Results Except for January and March 2023, every monthly number of predicted outpatient and emergency visits for 2023 matched the actual one relatively well. The average absolute percentage error for January to November 2023 was 8.504%. The actual total number of outpatient and emergency visits from January to November 2023 was 1441960, and the predicted value was 1417130 with a relative error of –1.722%. Conclusions ARIMA model can predict the outpatient and emergency visits of district-level hospitals relatively well. However, factors such as the high incidence of COVID-19 may affect the accuracy of short-term prediction.
ObjectiveTo understand the situation of off-label use of aspirin among outpatients in Sun Yatsen Memorial Hospital, so as to provide baseline data for developing off-label drug use policy.
MethodsA stratified random sampling method was used to collected prescription data of aspirin among outpatients in 2013. The incidence rates between different types of off-label use of aspirin were determined by chi-square test, and the influence factors of off-label drug use were analyzed by logistic regression model.
ResultsA total of 5 023 prescriptions with aspirin were collected and analyzed, with incidence rate of off-label use up to 17.7%. The major category of off-label use was no indication (94.38%). The top 3 no indications were recurrent abortion, infertility and systemic lupus erythematosus. Drug specification, gender, age and prescribed department were the risk factors of off-label use.
ConclusionAspirin off-label use is common among outpatients in Sun Yat-sen Memorial Hospital in 2013, especially in obstetrics and gynecology department and assisted reproductive center. The results suggest that more clinical studies about aspirin for reproduction are needed to provide more evidence of drug use, so as to ensure the safety of drug use in special populations and avoid potential medical risk.
After 5?12 When Chuan earthquake,The third hospital of Mianyang which is the nearest hospital of severely afflicted area recived 1 804 wounded persons.We aimed to summarize the achievement and limitation in management of medical rescue, medical treatment of the wounded and logistical support. Hospital shouled set up a special medical rescue system to relieve the sufferings of victims of unexpected natural calamities which include staff training, reserve supplies,psychological intervention of the wounded and safeguard of the rescuers.
ObjectiveTo investigate the evening outpatient service demand in West China Hospital, in order to provide better service.
MethodsUsing self-questionnaire, we investigated 1 734 outpatients and the data were analyzed with SPSS 16.0 software.
ResultsA total of 90.7% of the surveyed patients reported that it was necessary to have evening outpatient service, 53.1% of the patients were willing to come to the hospital in the morning, and 4.2% prefer to come to the hospital in the evening.
ConclusionEvening outpatient service in large general hospitals is getting high social affirmation. It is helpful to those who are inconvenient or unwilling to come to the hospital during day time, and is a complement for day-time outpatient and emergency outpatient service. Consultation time and resource arrangement in the evening outpatient service should conform to the principle of rational allocation for hospital resources.
Objective To verify the reliability and validity of a self-developed satisfaction evaluation questionnaire for outpatient department employees in public hospitals, and to provide suitable tools for conducting such surveys. Methods Two anonymous surveys were conducted on all employees of the Outpatient Department of West China Hospital of Sichuan University in July 2019 and November 2021, respectively. Questionnaire items were screened using methods such as item distribution, coefficient of variation, and decision value, and the reliability and validity of the questionnaire were evaluated using Spearman-Brown coefficient and Cronbach’s α coefficient, exploratory factor analysis, and confirmatory factor analysis. Results The final questionnaire retained 14 items, which could be divided into two dimensions: work conditions and interpersonal environment, and the overall fit index of structural equation model were as follows: χ2/ν=6.957, the standardized root mean square residual was 0.061, the root mean square error of approximation was 0.147, the goodness-of-fit index was 0.796, the adjusted goodness-of-fit index was 0.719, the normed fit index was 0.849, the relative fit index was 0.819, the incremental fit index was 0.868, the Tucker-Lewis Index was 0.841, and the comparative fit index was 0.867. The combined reliability of the two factors in the questionnaire was 0.94 and 0.91, respectively. The average variance extraction was 0.67 and 0.76, respectively, and the square root of the average variance extraction was 0.82 and 0.87, respectively, both of which were greater than the correlation coefficient of 0.71 between the two factors. The Spearman-Brown coefficient of the final questionnaire was 0.913, and the Cronbach’s α coefficients for the overall and two dimensions were 0.953, 0.937, and 0.910, respectively. Conclusion The reliability and validity of the satisfaction evaluation questionnaire for outpatient department employees in public hospitals are good and the questionnaire can be applied to practical surveys.
The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
ObjectiveTo investigate the status of antibiotic drug use in the outpatient department based on the special rectification activities of antibiotic drugs, identify the reasons for irrational use of antibiotic agents and propose the solutions.
MethodsPrescription of antibiotic drugs were analyzed by a retrospective comparative analysis during April to June 2011, August to October 2011 and August to October 2012.
ResultsPrescriptions of antibiotic drugs were 435 (36.25%), 367 (30.58%) and 223 (18.58%) during April to June 2011, August to October 2011 and August to October 2012, respectively, and the unreasonable prescriptions were 35 (2.92%), 27 (2.25%), and 14 (1.25%) respectively.
ConclusionThere is a decreased tendency of prescription of antibiotic drugs in the outpatient department of our hospital because of the special rectification activities of antibiotic drugs. It is in accordance with antibiotic use rate of <20% target of "antibiotics in 2012 special rectification program" in hospital outpatient service. But there are some unreasonable phenomena in the use of antibiotics, and to promote the reasonable use of antibiotics, we should strengthen management.
Objective To investigate the situation of MRI examination in children in outpatient and inpatient departments of the Sichuan Provincial People’s Hospital from 2010 to 2012, so as to provide favourable basis for the choice of imaging examination in children. Methods The materials of electronic reports of MRI examination in paediatric inpatient and outpatient departments from 2010 to 2012 were collected, categorized, and analyzed. Results a) 2 148 children underwent MRI examination in the Sichuan Provincial People’s Hospital from 2010 to 2012. The total number of patients increased with year. Boys were more than girls. The positive incidence was slightly decreased. The number of outpatients was more than inpatients, but the positive incidence was lower in outpatients. b) The total numbers of examination position were increased with year and the number of single position examination was the most (accounted for than 85% of the total numbers). The main examination positions included: head, MRA of the head, cervical column, knees, lumbar column, pituitary gland, thoracic column, and abdomen. The examination positions diversified gradually. The application of examination technique also increased gradually. c) The systemic disease spectrum of positive cases in MRI examination included 9 categories, which accounted for 42.86% of ICD-10. The nervous systematic disease, muscle, skeleton and connective tissue disease were the categories. The major disease types were stable during the recent 3 years. The increase was obvious in injuries of the knees, malacosis and atrophy of the brain, the deformity of the brain. Conclusion The total numbers of the patients and positions examined increased gradually with year in the Sichuan Provincial People’s Hospital from 2010 to 2012. The applications of MRI in the head, limbs and joints, and soft tissues were more extensive. Children diagnosed as positive results had diseases of the central nervous system, limbs and joints, and connective tissue disease.
ObjectiveTo understand the current situation of outpatient service, strengthen outpatient physicians management, maintain outpatient clinical order, and improve the credibility and service quality of public hospitals.MethodsThe measures such as deepening the supply-side reform of outpatient service, strengthening the awareness of integrity service, regulating suspending or substituting diagnosis service management, and optimizing doctors’ scheduling were performed to improve the outpatient service plan management since 2012. The data of outpatient diagnosis and treatment and doctor appraisals from 2013 to 2016 were retrospectively collected from hospital information system, combined with the third party satisfaction data; and the rates of suspending and substituting of outpatient service, clinical service time distribution for doctors at all levels, proportion of appointment register, and the average satisfaction index were analyzed.ResultsThe rates of suspending and substituting of clinical service reduced from 5.8% and 6.4% in 2013 to 2.5% and 4.1% in 2016, respectively, and the differences were statistically significant (P<0.05); the proportion of outpatient physicians with vice-senior title or above from 2014 to 2016 was lower than that in 2013, with the decrease from 81.0% in the morning and 73.0% in the afternoon to 75.9% and 69.1%, respectively; the proportion of appointment register increased from 54.7% in 2013 to 68.2% in 2016; the patients’ satisfaction was higher in 2016 than that in 2015.ConclusionThe outpatient service management of large general hospitals should be patients’ needs-oriented; with the awareness of integrity service, regulating the approval system of suspending or substituting of outpatient service, improving the pre-arranged planning for suspending service, optimizing the qualification admittance system, and improving the regular appraisal system, may effectively solve the problems of unbalanced outpatient physicians resources and service, maintain the good order of medical service, improve medical care quality, and raise patients satisfaction.
