Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data

Objective

To demonstrate the potential of de-identified clinical data from multiple healthcare systems using different electronic health records (EHR) to be efficiently used for very large retrospective cohort studies.

Materials and methods

Data of 959 030 patients, pooled from multiple different healthcare systems with distinct EHR, were obtained. Data were standardized and normalized using common ontologies, searchable through a HIPAA-compliant, patient de-identified web application (Explore; Explorys Inc). Patients were 26 years or older seen in multiple healthcare systems from 1999 to 2011 with data from EHR.

Results

Comparing obese, tall subjects with normal body mass index, short subjects, the venous thromboembolic events (VTE) OR was 1.83 (95% CI 1.76 to 1.91) for women and 1.21 (1.10 to 1.32) for men. Weight had more effect then height on VTE. Compared with Caucasian, Hispanic/Latino subjects had a much lower risk of VTE (female OR 0.47, 0.41 to 0.55; male OR 0.24, 0.20 to 0.28) and African-Americans a substantially higher risk (female OR 1.83, 1.76 to 1.91; male OR 1.58, 1.50 to 1.66). This 13-year retrospective study of almost one million patients was performed over approximately 125 h in 11 weeks, part time by the five authors.

Discussion

As research informatics tools develop and more clinical data become available in EHR, it is important to study and understand unique opportunities for clinical research informatics to transform the scale and resources needed to perform certain types of clinical research.

Conclusions

With the right clinical research informatics tools and EHR data, some types of very large cohort studies can be completed with minimal resources.     

首都医学发展科研基金立项评估指标体系的研究

目的 ：＂首都医学发展科研基金＂是北京市卫生系统内最重要的科研资金来源,也是目前＂首都卫生行业发展科研专项＂的前身和基础,本研究建立了＂首都医学发展科研基金＂立项评估的指标体系。方法：在同行评议的基础上采用改良后的特尔菲专家咨询法,通过两轮咨询形成一套立项评估指标体系,并用加权平均法计算指标权重。结果：第一轮专家评估的一级指标和二级指标协调系数分别为：0.47和0.23;第二轮专家评估的一级指标和二级指标协调系数分别为：0.60和0.29。结论：＂首都医学发展科研基金＂立项评估的指标体系经专家评估,协调系数均有不同程度提升,专家意见得到有效收敛,可以确定立项指标体系,并可以应用于目前＂首都卫生行业发展科研专项＂的立项评估中。     

Adrenocortical response to mating, social interaction and restraint in the female Japanese quail

In some species, the act of mating may be the only occasion when a female judges the male and the course of the sexual encounter might influence forms of maternal investment that are mediated by hormonal pathways. Despite the growing interest in fitness consequences of acute adrenocortical responses, it has not been determined to what extent the act of mating provokes such responses in females. We used female Japanese quail (Coturnix japonica) to determine to what extent any increase in corticosterone (CORT) is specific to actually mating with a male compared to visual and auditory contact with a male, and compared to social interaction with a female. We also asked if greater mating experience decreases the CORT response. We assessed how body condition of the individuals and their behavior during testing contributed to the variation in CORT response. As an additional reference for CORT increase we used a restraint procedure which resulted in the highest CORT. Our results show that females mating with a male have plasma CORT concentrations significantly increased from the baseline, which is not the case in females interacting with a male without the possibility of mating. Greater previous mating experience does not affect the CORT change caused by sexual interaction. Interestingly, social interaction with a female elicited a similar CORT response as mating with a male, which suggests that the effect on CORT was due to direct social interactions per se and not specific to the act of mating. Behavior during social and sexual interactions did not predict the CORT response, but larger females exhibited lower baseline and response CORT concentrations. We suggest that the lesser adrenocortical response of larger females might be related to their better control of the course of mating and might help them to adjust their reproductive investment, as reported in earlier studies.     

我国中西部地区新农合门诊统筹实施方案分析

随着新农合的发展,我国中西部地区逐步开展了门诊统筹试点工作,原本的家庭账户不再使用。本文通过研究中西部共18个地区实施的门诊统筹的实施方案,分别从筹资、补偿、管理、监督四个方面对方案进行统计分析,了解目前我国中西部实施门诊统筹地区的筹资水平、补偿比例、费用限额、监管手段等多个指标,并提出目前中西部地区实施门诊统筹存在的主要困难及其相应对策,为今后门诊统筹的政策制定和新农合的健康可持续发展提供相关参考。     

固定资产投资理论在医院投资决策中的应用

医院财务管理不能以利润最大化,或者说以结余最大化为目标,并不意味着医院不需要加强财务管理。资本投资理论,尤其是固定资产投资理论不但在企业投资中具有重要意义,在当前激烈的医院竞争中对怎样使固定资产投资发挥最大效益,怎样在固定资产投资、设备购置中为领导提供切实、可靠、有用的决策信息,提高医院固定资产的创收效益也有其重要的应用价值。本文着重讨论固定资产投资理论在医院固定资产更新改造中的应用。     

军队医院医疗项目投融资规范化管理

就军队医院医疗项目投融资的基本理论和方法进行了阐述,对其运营管理的现状进行了分析与评价,并对军队医院投融资规范化管理提出了建议。     

政府投资环境卫生工程项目的招标

分析了环卫工程招标的特点;从建设单位的角度,指出了政府投资环卫工程的2种主要审批方式,并从3个方面介绍了这2类环卫工程的招标活动;提出了招标文件编制中应当注意的问题。     

影响参保老年人医疗保险统筹基金平衡的因素研究

人口老龄化对医疗保险基金平衡构成巨大压力。以60~90岁参保的老年人医疗保险统筹基金支出和医疗保险统筹基金结余间关系,考虑年龄、保险规模、实际支付水平、医疗费上涨、基金保值等因素,研究代际转移支付制度应对老龄化背景下的医疗保险政策策略。研究表明,长期有效的维护医疗保险统筹基金平衡需要在现有医疗保险政策下,加强医疗保险基金的保值增值。一个较高的保值率才能满足医疗保险面对人口老龄化、医疗费用上涨的动态平衡。     

上海市嘉定区1999、2000、2001年60岁以上老年人1万元以上医疗费用的调查与分析

目的：通过对参加农村合作医疗区级大病风险基金60岁以上老年人1万元以上医疗费用的调查分析，初步了解60岁以上老年人1万元以上医疗费用的发生情况和趋势，提出完善保障老年人高额医疗服务的设想。方法：对嘉定区1999、2000、2001年三年中获得合作医疗区级大病风险基金补偿的60岁以上老年人1万元以上医疗费用、疾病发生情况、就诊流向，以及农村居民基本退休养老情况进行调查分析。结果；参加农村合作医疗区级大病风险基金60岁以上老年人1万元以上医疗费用发生人数、医疗费用、补偿金额均逐年上升。但是，他们的人均医疗费用和补偿低于整个人群，更低于60岁以下人群，老年人的高额医疗服务受到经济的制约，60岁以上老年人1万元以上医疗费用的疾病发病排列不同于本区出院疾病排列，相同疾病在不同级别的医院治疗费用不同。结论：60岁以上老年人是农村的弱势人群，他们的经济收入低微，对他们的高额医疗费用补偿要实行政策倾斜，对相同疾病的治疗要鼓励在能实施治疗的医院进行治疗，以保证老年人能看得起病，减轻家庭经济负担，防止因病致贫情况发生。要有针对性地开展对农村老年人进行健康筛选，对他们的慢性非传染性疾病进行干预和预防，使他们健康平安地度过晚年。     

探索农村合作医疗保险管理模式建立区,镇两级大病风险基金

为探索和完善农村合作医疗保险管理模式，本文对上海市嘉定区１０镇１９９４、１９９５两年的大病风险基金，千元以上高额医疗费用发生人数和经费使用情况进行了调查研究，并对部分干部和农民进行了个人交纳大病风险基金数、大 病风险基金补偿基线和比例的民意测评，提出了建立区、镇两级大产现风险基金，增强合作医疗抗风险能力，保障农民身健康的试行管理办法。