Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting

BACKGROUND: German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology. METHODS: A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003-06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail. RESULTS: It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed. CONCLUSIONS: The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.     

住院患者对专职陪护满意度调查

目的 了解住院患者对专职陪护的满意度,探索整体护理模式下专职陪护的培训方法.方法 以问卷形式调查有专职陪护的50例患者对陪护的满意度.结果 68%的住院患者对专职陪护满意,32%基本满意,没有患者表示不满意.最满意专职陪护能进行简单按摩、正确翻身等简单操作,比较不满意的是专职陪护的爱心、同情心不够及文化程度太低.结论 由医院进行统一管理的专职陪护基本上得到患者的认可,调动了社会支持系统,提高了患者的生活质量,但需要加强专职陪护的专业知识培训及提高其文化程度.     

1999～2006年大理州囊虫病住院病例流行病学特征分析

目的了解1999～2006年大理州囊虫病住院病例流行病学特征。方法收集并分析大理州血防所1999～2006年住院的所有大理籍囊虫病患者的病历档案。结果共有1792例囊虫病住院病例,其中男性多于女性,以7～15岁组、白族、大理市以及农村患者所占构成比最高,临床以脑型囊虫病为主（1703例,占95.03%）,临床表现以癫痫发作最为常见,其次是高颅压症状。56人有绦虫病史,占3.13%。结论大理州囊虫病感染方式以异体感染为主,并呈现出以大理市和洱源县为中心向周边地区扩散的态势。     

481例恶性肿瘤住院患者血栓发生情况分析

目的:通过观察记录恶性肿瘤患者血栓发生情况,分析其血栓形成的高危因素,对血栓的防治提供依据和指导.方法:选取自2014年1月以来住院接受化疗的肿瘤患者共481例,记录其临床生物学特征、实验室检查结果,观察记录患者血栓发生情况,分析其形成的高危因素.结果:总体血栓发生率为4.8％ (23/481),不同部位的肿瘤血栓发生率从高到低分别为肠道肿瘤8.3％ (3/36)、胃癌7.7％ (9/117)、肺癌4.7％ (6/128)、其他肿瘤2.9％ (3/104)和妇科肿瘤2.1％ (2/96);在23例血栓患者中,有1例患者在确诊前2周发现血栓形成,占血栓发生的4.3％(1/23);有11例患者在确诊时及确诊后的前3个月发现血栓形成,占47.8％ (11/23);有5例在确诊后3个月到6个月内发现血栓形成,占21.7％ (5/23),其余6例血栓发生在确诊后的6个月到2年内,共占26.1％(6/23).其中有95.7％ (22/23)的患者为中晚期,有69.6％(16/23)的血栓患者并无血栓相关症状.根据Khorana风险预测模型,高危患者的血栓发生风险高于低危患者.结论:应对住院接受化疗的肿瘤患者进行必要的筛查和预防,降低血栓的发生,改善患者的生活质量.     

Causes of pediatric mortality and case-fatality rates in eight Médecins Sans Frontières-supported hospitals in Africa

Setting:

Eight pediatric hospital in-patient wards in remote, rural and/or insecure areas in Africa.

Objectives:

To describe, in children aged <5 years, 1) overall and individual mortality rates, 2) the 10 most common causes of mortality, and 3) their case-fatality rates.

Design:

Retrospective analysis of routinely collected standardized program data for 2010.

Results:

During 2010, 21 357 children aged <5 years were admitted and 1520 died, resulting in an overall in-patient mortality rate among under-fives of 7%. This remained the same after considering the three most common causes of mortality per hospital. One hospital with a neonatal unit showed a mortality rate of 14%. Of the 10 most common causes of mortality in the eight hospitals, severe malaria, acute lower respiratory tract infection and neonatal infection counted for about 77% of total deaths. Ranking the 10 most common causes of mortality according to case-fatality rates, septicemia, meningitis, low birth weight with pathology, neonatal infection and neonatal asphyxia were the most common (case-fatality rates 15–40%).

Conclusion:

Despite widely different contexts, mortality rates for pediatric in-patients were consistently under 10%. To further reduce mortality, emphasis should be placed on treating sepsis and introducing implementable and/or adapted care packages for neonatal-related pathologies.     

品管圈活动在降低感染科陪护率中的应用

目的:探讨品管圈活动在降低感染科患者陪护率中的应用。方法:成立品管圈,确立"降低感染科陪护率"的活动主题,运用PDCA循环原则,进行现状调查、要因分析、实施对策制订、效果检验、效果巩固等,便利抽取44名住院患者及40名家属进行现状调查,分析导致陪护滞留病房的根本原因,制定相应的对策并组织实施,并进行效果检查。结果:实施品管圈活动后,感染科陪护率从75.76%下降至37.50%(P<0.01);住院患者的满意度从91.67%上升至98.61%(P<0.01)。结论:品管圈活动可降低感染科陪护率,提高患者满意度。     

住院病人肠道寄生虫卵检查结果分析

目的：了解住院病人肠道寄生虫感染状况。方法：收集40207例患者粪便标本，检查蛔虫、钩虫、鞭虫、华支睾吸虫卵。结果：检出有寄生虫感染者4248例，总感染率为10.55％。其中，蛔虫、钩虫、鞭虫、华支睾吸虫感染率分别为2.64％、2.65％、0.67％、4.59％，2种以上寄生虫混合感染（多寄生现象）率为0.28％。结论：住院病人蛔虫、钩虫、鞭虫感染率逐年下降，而华支睾吸虫感染率则逐年上升。     

住院患者自杀行为分析及护理对策

目的探讨住院患者实施自杀行为的相关因素，制订并采取综合性的防范自杀行为的护理对策。方法自2003年起在全院实施防止患者非正常死亡的护理防范措施，分析采取护理防范措施前后5个年度自杀行为发生情况的差异。结果采取综合性的护理防范措施后的5个年度住院患者自杀行为的发生率明显下降，同采取护理防范措施前的5个年度相比有显著性差异（P〈0．01）。结论做好自杀倾向的评估判断，加强病房的安全管理，重视晚期肿瘤患者的护理及增加医疗收费的透明度，有助于及时发现有自杀倾向的患者。     

综合医院艾滋病住院患者的护理管理研究

目的探讨艾滋病住院患者护理管理方法。方法成立艾滋病专科护理小组,建立患者信息档案并制订艾滋病住院患者管理方法,包括建立艾滋病患者诊疗绿色通道、尊重患者保护隐私、促进患者与家属沟通、促进患者心理健康状况、高效联合抗逆转录病毒治疗用药管理等。结果患者出院时焦虑/抑郁率比入院时降低,会诊时间与住院日均缩短,口服药依从性提高。结论艾滋病住院患者进行综合护理管理可有效降低焦虑/抑郁发生率,缩短会诊时间与住院日,提高服药依从性。     

Hospital admission for acute pancreatitis in the Irish population, 1997 2004: could the increase be due to an increase in alcohol-related pancreatitis?

OBJECTIVE: To investigate trends in the incidence of acute pancreatitis by examining emergency admissions to acute public hospitals over an 8-year period; to compare trends for alcohol-related pancreatitis admissions with biliary tract-related admissions and to profile the patients admitted with an acute pancreatitis diagnosis. METHODS: All in-patient emergency admissions for which an acute pancreatitis diagnosis (ICD-9-CM Code 577.0) was recorded as principal diagnosis were identified for years 1997-2004 inclusive. Alcohol-related acute pancreatitis admissions (i.e. had alcohol misuse recorded as co-morbidity) were identified using ICD-9-CM-codes 303 and 305. Biliary tract disease-related admissions (i.e. had biliary tract disease recorded as co-morbidity) were identified using ICD-9-CM codes 574.0-576.0 inclusive. Pearson's chi2-test was used to compare proportions in groups of categorical data and chi2-tests for trend were used to identify linear trends. RESULTS: There were 6291 emergency admissions with a principal diagnosis of acute pancreatitis during the 8 year study period, with 622 admissions in 1997 compared to 959 admissions in 2004, an increase of 54.1%. Age standardized rates rose significantly from 17.5 per 100,000 population in 1997 to 23.6 per 100,000 in 2004, (P<0.01 for linear trend). There were 1205 admissions with alcohol misuse recorded as a co-morbidity increasing from 13.9% (87/622) of acute pancreatitis admissions in 1997 to 23.2% (223/959) in 2004. This increase was significantly greater than the increase observed for biliary tract disease-related admissions, 19.6% (122/622) in 1997 to 23.5% (225/959) in 2004. Rates for total acute pancreatitis admissions were highest in those aged 70 years and over; the majority (3563, 56.6%) of the admissions were male with a mean age of 51.1 years (SD 19.9); the mean age for male admissions was significantly younger than for female admissions (49.1 versus 53.6 years, P<0.001). However, for alcohol-related admissions, rates were highest in those aged 30-49 years and patients admitted with alcohol misuse recorded were significantly younger than those who did not have alcohol misuse recorded (42.0 versus 53.2 years, P<0.001). Median length of stay was 7 days. CONCLUSIONS: Hospital admissions for acute pancreatitis rose from 17.5 per 100,000 population in 1997 to 23.6 per 100,000 in 2004. The proportion of admissions that had alcohol misuse recorded as a co-morbidity rose more markedly than those with biliary tract disease and the rise was more pronounced in younger age groups. The increasing trend in alcohol-related acute pancreatitis parallels the rise in per capita alcohol consumption. Given the continuing rise in binge drinking, particularly among young people, this is a cause for concern.