Effects of computer-assisted documentation in orthopedic surgery on budget and reimbursement

Summary Since 1995 German health maintenance laws require hospitals to document and code all referals, admissions and discharges using the 4-digit ICD. Operative procedures are documented and coded using the ICPM. Beginning in January 1996, reimbursement for health services requires a diagnosis-related billing and payment for special procedures. The decision for billing is based on documented diagnosis and therapy. This extended request for documentation makes an online access to diagnosis and therapy with a computer-assisted coding system advisable. In 1996 in our hospital each diagnosis and operation was manually documented and coded on a form. Since the beginning of 1997, documentation and coding has been exclusively computer-assisted. On the basis of documented diagnosis and therapy the computer provides the route of reimbursement. Retrospectively we evaluated the number of charged diagnosis-related billings and payments for special procedures from January to April of 1996 and 1997. It became evident that with computer-assisted documentation and coding the number of detected and charged diagnosis-related billings and payments for special procedures was significantly increased in comparison with the previous year.      

Special Hospital seclusion and its clinical variations

Summary

• ? The terminology used in the published literature to indicate that a patient is being denied, or is denying themself, the company of other people is wide and varied.
• ? With ever growing concerns of the rights, both civil and legal, of patients receiving treatment, either solicited or unsolicited, there is a need to identify the patterns of practice in any given organization and to establish their relationship to the terminological semantic.
• ? The Special Hospitals, who cater for those patients requiring a high degree of security, have been assumed to use seclusion to a greater degree than any other form of personal-space facility, either forced by the staff or elected by the patient. However, this has largely been based on hearsay and speculation.
• ? Seclusion may be perceived as a clinical psychiatric intervention to prevent the serious deterioration of a person's mental state or as a method of containment of a dangerous situation when all else fails.
• ? This study was based on a survey of all seclusion facilities within the Special Hospital system and discussions with over 100 nursing staff about the differing types and methods of providing patient withdrawal from the ward community for whatever reason.
• ? The results highlighted a clear uniformity of practice throughout the system despite the differing terminologies used.

     

特区经济学的理论前提

实行特殊政策和实施特殊管理体制是世界经济特区共有的基本特征。正是这两个基本特征构成了特区经济学的两个理论前提。对经济特区实行特殊政策和实施特殊管理体制进行理论分析 ,目的在于为构筑特区经济学的理论体系作理论上的准备     

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform: Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management. It is a common requirement to reuse the data for clinical research. However, we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform. In this paper, we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology. We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform. Secondly, we built special disease case repositories (i.e., heart failure repository) that utilize the graph to search the related patients and to normalize the data. Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure, we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository. After the propensity score matching, the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired. Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients. This paper presents the workflow and application example of big data mining based on regional EHR data.     

Prognostic factors of single‐visit endodontic and restorative treatment under general anaesthesia for special needs patients

The aim of this study was to evaluate the longevity of teeth with single‐visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed‐up for 6–81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow‐up were compared. Kaplan–Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5‐year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5‐year success rate = 86·4%). Risk factors associated with survival were age (>40), non‐parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single‐visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient‐ and dental‐specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth.     

The Financial Impact of a Hospital-Based Care Coordination Program for Children With Special Health Care Needs

Care coordination programs are important in caring for medically complex pediatric patients, particularly for children with special health care needs. This study is a retrospective financial analysis of a hospital-based care coordination program involving one procedural subgroup of children with special health care needs: those receiving pediatric tracheostomy. Hospital records were reviewed for patients who received a tracheostomy at a large Midwestern U.S. hospital from 1999 through 2015. The population was divided into two subgroups: patients who received a tracheostomy before the development of a care coordination program and patients who received a tracheostomy after enrollment in the care coordination program. Patient records were reviewed for length of stay, readmissions related to respiratory and tracheostomy management, and total hospital charges. Enrollment in a care coordination program for the pediatric tracheostomy patient resulted in a decrease in mean length of stay and reduced hospital charges and a slight increase in readmissions. Further analysis using larger sample sizes and multiple centers is necessary to determine whether such outcomes are the direct result of enrollment in a care coordination program.     

BOOK REVIEWS

No abstract available for this article.     

麻醉科围术期专科数据库的建设和应用

分析基于大数据平台的麻醉科围术期专科数据库辅助临床决策的技术方案和实践经验。阐述基于大数据平台的麻醉科围术期专科数据库的应用形式,介绍如何构建高质量、可计算的围术期大数据知识架构和实践流程,并在围术期并发症的提取场景中得以应用。大数据技术在围术期专科数据库的开发和应用,可以为手术科医师提供精准、高效、便捷的围术期并发症提取、危险因素分析和预测模型。对于提高患者围术期的安全性、改善患者的预后以及建立危险因素预测模型起着重要的作用。