大型医用设备检查治疗项目标准成本核算及应用分析*

目的：核算大型医用设备检查治疗项目标准成本并开展应用分析,为破解医院精细化成本核算难题及后续大型医用设备检查治疗项目价格动态调整提供循证基础。方法：选取样本医院CT、MRI两类大型医用设备中8类检查治疗项目, 运用实地观察法、估时作业成本法开展标准成本核算。结果：CT类检查治疗项目人力成本占比较高,平均为42.77%;MRI类检查治疗项目专用设备占比较高,平均为52.48%;样本项目价格补偿率整体较高,平均达108.0%,尚存在降价空间;预约登记、辅助作业中心整体均存在闲置产能。结论：项目标准成本对于医院实现精细化管控大型医用设备检查治疗项目成本及动态调价意义重大,可作为提升大型医用设备检查治疗项目成本管控水平、优化资源配置效率以及实施“分步—分类”精准化项目定调价的核心依据。     

三种大型医用设备使用适宜性评价及分析

目的:分析样本医院大型医用设备利用适宜性水平,为我国大型医用设备合理使用提出建议。方法:采用专家临床评价的方法,对现场调查获得的住院病例进行评阅。利用Epidata3.1进行数据录入,SPSS16.0进行统计描述和检验。结果:CT、MRI、DSA合理利用的比例分别为86.47%、90.49%和97%。其中,CT利用不足和过度利用的比例分别为9.30%和4.23%,MRI分别为8.89%和0.62%,DSA不合理利用的病例均为利用不足。Logistic回归显示患者年龄和就诊科室对设备利用的适宜性有一定影响。结论:大型医用设备的使用总体适宜,供方因素导致的不合理利用较明显。卫生行政部门应制定合理的评价标准,科学评价大型医用设备使用的适宜性。     

云南省西双版纳州乙类大型医用设备配置及使用现状调查

[目的]了解西双版纳州乙类大型医用设备分布和使用情况,为制定西双版纳州乙类大型医用设备的配置标准和规划提供参考依据。[方法]计算西双版纳州五种乙类大型医用设备每百万人占用量、平均使用率(%)、平均阳性检出率(%)等指标,并测算MRI与CT实际使用中的技术效率指标。[结果]西双版纳州有乙类大型医用设备总量是14台/套,每百万人拥有12.39台;CT和MRI及LA的平均使用率均超过了100%,但是CT的阳性检出率不到80%;MRI的年能力利用率为93.92%,CT的年能力利用率为142.73%。[结论]西双版纳州乙类大型医用设备每百万人拥有量不低,使用率很高,但诱导需求仍然存在,MRI的工作量处于不饱和状态,CT的工作量处于超负荷状态。     

河南省乙类大型医疗设备配置规划研究

目的:为使卫生资源的供给与医疗卫生服务需求相一致,按照科学、合理、公平和效益的原则,在现状调查分析的基础上,制定河南省乙类大型医疗设备配置标准,以提高卫生资源的使用效益。方法:采用普查法和抽样调查法相结合,对河南省乙类大型医用设备的相关资料进行了调查。并采用目标服务法,综合考虑河南省社会经济发展、医疗服务需要等因素,对河南省2005年和2007年CT和MRI等乙类大型医用设备的控制总量和增量准入标准进行探讨。结果:CT、MRI数量分布和医院数量所占比例大致吻合。平均每所医院的CT拥有量为1.08台,MRI为1.00台。省市县级医院2004年CT平均检测次数分别为8818人次、8788人次和6677人次,MRI分别为4863人次、3050人次和2247人次;省级医院MRI的年工作量是县级的2倍。CT阳性率分别为84.00%、76.00%和69.00%,MRI阳性率分别为91.00%、81.00%和81.00%。结论:CT的拥有量基本上已经满足需求;有些单位MRI的使用率较低,存在较大的潜力。MRI出现了过剩现象。     

脑脊液及颅脑MRI增强扫描对颅内结核的诊断价值研究

目的：研究脑脊液、颅脑磁共振成像(MRI)增强扫描对颅内结核的诊断价值。方法：对医院收治的400例颅内结核患者进行分析,所有患者均行脑脊液检查及MRI平扫、增强扫描,分析患者脑脊液改变及MRI影像学表现。结果：400例颅内结核患者中,MRI平扫检查异常患者292例,诊断阳性率为73%;增强扫描检查异常患者341例,诊断阳性率为85.25%;脑脊液检测异常患者305例,诊断阳性率为76.25%。MRI增强扫描诊断阳性率高于脑脊液检测,差异有统计学意义(x²=10.422,P<0.05),两者联合诊断阳性率(91.00%)高于MRI、脑脊液单项诊断,差异有统计学意义(x²=6.319,x²=31.776;P<0.05);MRI及脑脊液检测对颅内结核诊断存在一致性,且一致性良好(Kappa=0.619,P<0.05)。结论：颅脑MRI及脑脊液检查各具侧重点,且一致性良好,可相互补充,对临床脑脊液检测阴性的疑似病例行MRI增强扫描,可提高诊断准确率,为颅内结核的诊断鉴别提供可靠证据。     

胶体金法快速检测霍乱弧菌诊断试验的研究设计与分析

目的：评价胶体金法对霍乱弧菌检测的真实性、可靠性和实用性，探讨其应用价值。方法：用血清凝集试验方法作为金标准，并用胶体金方法对同一份标本进行检测，对胶体金方法的诊断试验的评价指标作出计算。结果：两种方法的检测结果之间有极好的一致性（φ=0．943，Kappa=0．941），胶体金法诊断霍乱与金标准方法的差异无统计学意义（P〉0．05），胶体金法检测霍乱弧菌诊断试验的灵敏度为93．18％，特异度为100％，阳性预测值为100％，阴性预测值为95．38％，假阴性率为6．82％，假阳性率为0。结论：胶体金法在基层霍乱检测工作中具有一定的应用价值，该方法的特异性高，一致性也较高，但其灵敏度仍有待提高。     

河南省大型医疗设备现状分析

目的:全面掌握河南省大型医疗设备的拥有量、分布、使用率等资料,为编制河南省乙类大型医用设备配置规划提供科学依据.方法:采用普查法和抽样调查法相结合,对河南省乙类大型医用设备的相关资料进行调查.结果:CT、MRI在各级医院和各类医院的数量分布和比例分布较为合理.乙类大型医疗设备数量增长速度较快,不同级别医院工作量和设备检测的阳性率差别较大.结论:乙类大型医疗设备的数量分布和比例分布已经满足需求;适当控制过高的增长速度;注意提高乙类大型医疗设备的利用率和设备检测的阳性率.     

蓝激光内镜联动成像模式诊断幽门螺杆菌感染的价值

目的 分析蓝激光内镜联动成像(LCI)模式在幽门螺杆菌(Hp)感染中的临床诊断价值。方法 选取2021年1月至2022年10月被晋江市医院消化内科门诊诊为疑似Hp感染的118例患者为研究对象,所有患者均先后进行尿素呼气试验和蓝激光内镜LCI模式下取病理组织活检检查。分析两种诊断方法与病理金标准诊断结果的一致性,以及两种诊断方法的差异。结果^(13)C尿素呼气试验诊断结果与病理金标准诊断结果比较,阳性率为96.1%、阴性率为95.1%;蓝光内镜LCI模式下诊断结果与病理诊断金标准诊断结果比较,阳性率为100%、阴性率为90.2%;两种诊断方法与病理金标准诊断结果的一致性较好,灵敏度和特异度比较,差异无统计学意义(P>0.05)。结论 蓝激光内镜LCI模式下诊断Hp感染与病理金标准诊断结果一致性较好,且具有较高的敏感度和特异度,可作为辅助诊断Hp感染的一种新方法。     

中部A省大型医用设备配置公平性评价

目的 :对大型医用设备配置许可证政策实施后的A省大型医用设备配置公平性进行评价,并对优化大型医用设备配置管理提出政策建议。方法:采用基尼系数、泰尔指数和集中指数评价A省计算机断层扫描(CT)、磁共振成像(MRI)配置的公平性和变化趋势,并通过泰尔指数分解和集中指数分析经济因素对公平性的影响。结果:2005—2013年,CT和MRI的按人口配置的基尼系数、MRI按地理配置的基尼系数、CT和MRI的泰尔指数和MRI集中指数均呈下降趋势,CT按地理配置的基尼系数和集中指数略微上升。2005—2013年CT和MRI的泰尔指数分解显示,组内差异对泰尔指数贡献率基本保持在80%以上。结论 :大型医用设备配置管理政策的实施促进了A省基于人口的CT、MRI的配置公平性,但基于地理的CT配置公平性有所降低;区域内差异是造成A省CT设备配置不公平性的主要原因,而经济因素对CT、MRI配置公平性的影响不大。     

MRI对胆囊良性与恶性病变的鉴别诊断效果分析

目的：探讨MRI对胆囊良性与恶性病变的鉴别诊断效果及价值。方法：选取2018年12月～2020年12月本院接收的29例恶性胆囊病变患者与43例良性胆囊病变患者,分别对其开展MRI检查,通过对不同病变患者的检查结果进行比较来评价MRI在胆囊良性与恶性病变中的鉴别诊断效果,并以Kappa检验判定其诊断的一致性。结果：72例患者的MRI检查显示良性41例,恶性31例,阳性预测值为87.1%,阴性预测值为95.1%,灵敏度为93.1%,特异度为90.7%,诊断一致性为91.7%,MRI检查与病理诊断结果的一致性Kappa值为0.827,具有较好的一致性。结论：MRI有助于鉴别胆囊良性病变与恶性病变,与实验室病理诊断结果具有较高的一致性,适宜使用在胆囊良恶性病变的鉴别诊断中。     

大型医疗设备巡查对提高设备使用效率的技术分析

目的探讨大型医疗设备巡查对提高设备使用的效率。方法对我院大型医疗设备巡查进行技术分析,重点以CT和PET-CT等放射诊断设备的球管、MRI超导磁体中的液氦为案例进行量化分析。结果更换球管基本实现"零停机",并确保了MRI的液氦量在安全范围内,降低了MRI发生"失超"的风险。结论大型医疗设备重要部件关键数据收集和记录对提高设备使用效率具有重要的参考价值,可为医疗设备的预防性维修提供数据支持,为医疗设备的量化管理提供科学的依据。     

大型医疗设备巡查对提高设备使用效率的技术分析

目的探讨大型医疗设备巡查对提高设备使用的效率。方法对我院大型医疗设备巡查进行技术分析,重点以CT和PET—CT等放射诊断设备的球管、MRI超导磁体中的液氦为案例进行量化分析。结果更换球管基本实现“零停机”,并确保了MRI的液氦量在安全范围内,降低了MRI发生“失超”的风险。结论大型医疗设备重要部件关键数据收集和记录对提高设备使用效率具有重要的参考价值,可为医疗设备的预防性维修提供数据支持,为医疗设备的量化管理提供科学的依据。     

三维快速自旋回波与常规序列诊断膝关节交叉韧带损伤的对比研究

目的:研究三维快速自旋回波(3D-SPACE)序列扫描对膝关节交叉韧带损伤的诊断价值。方法:选取医院收治的56例膝关节交叉韧带损伤患者,入院后均完成磁共振成像(MRI)常规序列扫描和3D-SPACE序列扫描,以关节镜检查为对照,比较3D-SPACE序列与常规序列诊断膝关节交叉韧带损伤的灵敏度、特异度和准确率,以及图像主观评分等级。结果:MRI常规序列诊断膝关节交叉韧带损伤灵敏度、特异度和准确率分别为87.80%、86.67%和85.96%;MRI 3D-SPACE序列诊断灵敏度、特异度和准确率分别为95.12%、93.33%和94.64%,3D-SPACE序列与关节镜检查吻合度(k=0.921,P<0.05)优于MRI常规序列(k=0.681,P<0.05);常规序列诊断完全撕裂、部分撕裂与关节镜符合度分别为85.71%(36/42)和92.86%(13/14),3D-SPACE序列诊断完全撕裂、部分撕裂与关节镜符合度分别为95.24%(40/42)和92.86%(13/14),两者比较差异无统计学意义。MRI两种序列诊断膝关节交叉韧带损伤图像主观评分等级比较差异无统计学意义(x^2=1.813,P>0.05)。结论:3D-SPACE对膝关节交叉韧带损伤软组织分辨率高,可清晰显示关节结构、韧带损伤情况,与关节镜诊断符合度高,诊断效能优于MRI常规序列。     

Demand forecasting for magnetic resonance imaging services

Healthcare providers interested in acquiring MRI technology are finding it difficult to assess demand and, therefore, financial feasibility. This article presents a quantitative technique for MRI demand forecasting that interrelates the known applications of MRI to the specific clinical setting in which it is to be employed. The first step in this technique is to identify the number of patients with diagnoses for which MRI is known to be applicable. Next, each of these diagnoses is weighted according to the percent of patients who are expected to receive MRI scans versus other diagnostic modalities. Finally, the number of patients in each diagnosis is multiplied by the weighting to estimate the number of patients for whom MRI scans can be expected. This technique was used by a consortium of three major community hospitals in Omaha, Nebraska, as the basis of their demand forecasting and was used in successfully obtaining a Certificate of Need.     

Preemployment medical examinations in a large occupational health service.

Several hundreds of thousands of preemployment medical examinations are performed in The Netherlands each year, with the objective of screening for obvious risks for the applicants or others. Neither the efficacy of these examinations nor determinants for rejection are known. Altogether 101,754 preemployment medical examinations of applicants for governmental functions were analyzed. For one-fifth of the applicants some medical diagnosis was recorded. The overall rejection percentage was 0.6%, being highest for job categories involving public safety and high physical demands, but never exceeding 4%. Age was positively correlated with rejection percentage. Except for the diagnostic category "disorders of the musculoskeletal system" no relation between diagnostic category and job demands was apparent. Medical diagnoses frequently encountered among rejected applicants were also common among successful applicants. If selection aiming at reducing absenteeism or work disablement is considered to be the only goal of preemployment medical examinations, then their efficacy appears to be low for many job categories.     

急性重症胰腺炎CT诊断临床分析

目的:本文主要探究螺旋CT、MRI应用在SAP(急性重症胰腺炎)中的诊断准确率,对两种诊断方式(CT、MRI诊断)在临床中的诊断价值展开评估。方法:纳入本次研究的40例患者为本院2017年1月~2019年1月收治的急性重症胰腺炎患者,均经两种方式进行诊断,即为多层螺旋CT(第一组)、MRI诊断(第二组),分析两组诊断结果存有的差异,对螺旋CT、MRI应用在SAP中的价值进行相应的评价。结果:第一组CT诊断准确共38例,准确率为95.0%;第二组MRI检查之后37例诊断准确,准确率为92.5%;第一组患者经相应的诊断之后其准确率和第二组的准确率间对比无差异,组别间数据的分析和比对无统计学意义(P>0.05)。第一组经相应的诊断之后其漏诊率、误诊率和第二组间对比无差异,组别间数据的分析和比对无统计学意义(P>0.05)。结论:SAP患者在临床中经应用不同的诊断方式螺旋展开检查,CT、MRI均可良好的诊断效果,有效的保障诊断准确率得以进一步提升,临床主治医师可按照诊断结构为患者制定出与其相符合的治疗方案,进而保障患者预后的改善。在SAP患者的MRI和螺旋CT诊断结果比较统一,诊断准确率比较高,但MRI诊断仪器价格比较高,推广容易受到临床的限制。     

急性重症胰腺炎CT诊断临床分析

目的:本文主要探究螺旋CT、MRI应用在SAP(急性重症胰腺炎)中的诊断准确率,对两种诊断方式(CT、MRI诊断)在临床中的诊断价值展开评估。方法:纳入本次研究的40例患者为本院2017年1月~2019年1月收治的急性重症胰腺炎患者,均经两种方式进行诊断,即为多层螺旋CT(第一组)、MRI诊断(第二组),分析两组诊断结果存有的差异,对螺旋CT、MRI应用在SAP中的价值进行相应的评价。结果:第一组CT诊断准确共38例,准确率为95.0%;第二组MRI检查之后37例诊断准确,准确率为92.5%;第一组患者经相应的诊断之后其准确率和第二组的准确率间对比无差异,组别间数据的分析和比对无统计学意义(P>0.05)。第一组经相应的诊断之后其漏诊率、误诊率和第二组间对比无差异,组别间数据的分析和比对无统计学意义(P>0.05)。结论:SAP患者在临床中经应用不同的诊断方式螺旋展开检查,CT、MRI均可良好的诊断效果,有效的保障诊断准确率得以进一步提升,临床主治医师可按照诊断结构为患者制定出与其相符合的治疗方案,进而保障患者预后的改善。在SAP患者的MRI和螺旋CT诊断结果比较统一,诊断准确率比较高,但MRI诊断仪器价格比较高,推广容易受到临床的限制。     

The validity of a presumptive diagnosis of cutaneous leishmaniasis performed by community health workers in Colombia]

OBJECTIVE: To validate a method for the presumptive diagnosis of cutaneous leishmaniasis based on the observation of clinical-epidemiological criteria, carried out by community health workers in three endemic municipalities in Santander, a department in northeastern Colombia. METHODS: This evaluation study of diagnostic technologies was based on a cross-sectional sampling of suspected cases of cutaneous leishmaniasis in the municipalities of Rionegro, El Playón, and Landázuri. After being trained, the community health workers carried out the presumptive diagnoses of cutaneous leishmaniasis between October 2004 and November 2005. At the time of diagnosis, the health workers also collected samples for confirmatory diagnosis through Field's stain method, culturing, and polymerase chain reaction. Four criteria were used to assess the validity of the presumptive diagnoses carried out by the health workers: sensitivity, specificity, positive predictive value, and negative predictive value. Replicability among the health workers was estimated through their observed level of agreement. RESULTS: According to the laboratory tests, of the 196 patients studied, 33 (16.8%) were negative and 163 (83.2%) were positive. For all the levels of certainty of the clinical diagnosis, the sensitivity was between 52% and 98% (kappa(1, 0) = 39.0%) and the specificity between 9% and 55% (kappa(0, 0) = 14.0%). The area under the receiver operating characteristic curve was 56.5% (95% confidence interval: 45.6% to 67.4%). The proportion of positive agreement and of negative agreement was 86.3% and 43.5%, respectively. CONCLUSIONS: The sensitivity of the presumptive diagnosis carried out by the health workers surpasses that of the parasitological diagnostic methods generally used in the three endemic areas, but its specificity is much lower. Even though this approach is not useful as a diagnostic test for cutaneous leishmaniasis or as a criterion for deciding to proceed with treatment or not, the method is useful for the active identification of cases in the community.     

Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study

Background  

The increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which may influence physicians' documentation behaviour. For that reason it is unclear to what respect ICD-10 codes reflect the real problems of the patients in general practice. The aim of this study was to assess the appropriateness of the recorded diagnoses and to determine what diagnostic information is used to guide medical treatment.     

Diagnoses, requests and timing of 503 psychiatric consultations in two general hospitals

The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time). This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%), adjustment disorder (10.9%) and cognitive disorder (7.6%). In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13). Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.