Ao-Ya Liu,1,2,* Kai-Ran Yu,1,* Ping Zhou,1,* Tuo Ji,1 Xun Liang,3 Zheng-Dong Xu,1 Xu-Lin Chen,1 Fei Wang1 1Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China; 2Department of Burns and Plastic Surgery, Xuzhou First People’s Hospital, Xuzhou, Jiangsu 221116, People’s Republic of China; 3Department of Emergency, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230022, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fei Wang, Department of Burns, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, People’s Republic of China, Tel +86-551-6590-8497, Email wangfei@fy.ahmu.edu.cnBackground: Identifying variables that contribute to sepsis in necrotizing fasciitis (NF) remains a critical clinical challenge. This study aimed to identify the independent predictors of sepsis progression in NF patients and develop a clinical nomogram to identify those at high risk.Methods: A total of 271 NF patients from two medical centers were enrolled and randomly assigned to a training set (n = 164) and a validation set (n = 107) at a 6:4 ratio. Predictors of sepsis were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression. The nomogram’s performance was evaluated via calibration curves, decision curve analysis (DCA), and the area under the receiver operating characteristic curve (AUC).Results: Sepsis developed in 77 (28.4%) of the 271 patients. Multivariate analysis identified four independent predictors: age-adjusted Charlson comorbidity index (aCCI), procalcitonin (PCT) > 2 ng/mL, serum bicarbonate, and activated partial thromboplastin time (APTT). The nomogram demonstrated robust discriminative ability, with an AUC of 0.837 (95% CI: 0.769– 0.905) in the training set and 0.829 (95% CI: 0.734– 0.923) in the validation set. Calibration curves showed high agreement between predicted and observed outcomes. DCA indicated clinical utility within a threshold probability range of 7– 74% for the training set and 6– 79% for the validation set.Conclusion: We successfully developed and validated a nomogram incorporating aCCI, PCT, serum bicarbonate, and APTT. This tool may assist the early identification of high-risk patients and support individualized monitoring; however, external validation is still required before broad clinical implementation, and the nomogram should not replace clinical judgment.Keywords: necrotizing fasciitis, sepsis, nomogram, risk prediction
Deep Shikha, Sunita SharmaMaharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, 133207, IndiaCorrespondence: Sunita Sharma, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University (Deemed to be University), Mullana, Haryana, 133207, India, Tel +91 9467633734, Email ptsunitasharma81@gmail.com
Huawei Tan,1,2 Hao Fang11School of Public Management, Chongqing Technology and Business University, Chongqing, 400067, People’s Republic of China; 2Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of ChinaCorrespondence: Hao Fang, Email 1012288379@qq.comBackground: Hospital accreditation aims to strengthen hospital capacity and improve quality of care, but its effects on inpatient expenditure, patient cost sharing and quality remain unclear. We estimate these effects in county-level public hospitals in China.Methods: We use administrative claims data from Zunyi, China. Four county-level public hospitals that passed tertiary hospital accreditation in 2021 comprise the treatment group. The control group comprises 17 hospitals that remained at the secondary level. We analyse 6844 heart failure admissions among adults aged 18 years or older from December 2020 to November 2022. The eligible cohort comprised 6,844 admissions; after matching, the analytical cohort comprised 3,920 admissions, and 3,874 were eligible for the readmission analysis. We combine propensity score matching with a difference-in-differences model to estimate the effects on total health expenditures per inpatient case, out-of-pocket costs per inpatient case, the patient cost-sharing rate and the 30-day all-cause readmission rate.Results: Hospital accreditation increased total health expenditures per inpatient case by 3.99% (P = 0.046). It did not significantly change out-of-pocket costs (− 8.00%, P = 0.304), the patient cost-sharing rate (− 2.12 percentage points, P = 0.143) or the 30-day all-cause readmission rate (+3.96 percentage points, P = 0.117). In subgroup analyses, total health expenditures increased significantly among both URRBMI and UEBMI inpatients and among inpatients admitted to Traditional Chinese Medicine hospitals. No subgroup showed a significant reduction in the 30-day all-cause readmission rate.Conclusion: Our estimates indicate that tertiary hospital accreditation increased total health expenditures per inpatient case but did not significantly alter patient cost sharing or the 30-day all-cause readmission rate. Post-accreditation evaluation should jointly assess expenditures across the episode of care, financial protection and quality of care.Keywords: hospital accreditation, inpatient expenditures, patient cost sharing, quality of care, heart failure
Feng-Jun Tian,1 Yong Zhang,1 Jiang-Ke Tian,2 Hong-Li Cui,2 Ping Song31Psychological Health Center, Beijing United Family Rehabilitation Hospital, Beijing, 100016, People’s Republic of China; 2Ultrasound Department, Beijing United Family Hospital, Beijing, 100015, People’s Republic of China; 3Medical Affairs Office, Beijing United Family Rehabilitation Hospital, Beijing, 100016, People’s Republic of ChinaCorrespondence: Feng-Jun Tian, Email tianfengjun29@163.comObjective: To develop and internally validate a prediction model for a first episode of clozapine-induced gastrointestinal hypomotility (CIGH) in clozapine-treated psychiatric inpatients.Methods: In this single-center retrospective cohort study, 1,426 adults with schizophrenia, schizoaffective disorder or bipolar disorder who had received clozapine for at least 4 weeks and were admitted to the Department of Psychiatry of Beijing United Family Rehabilitation Hospital between January 2019 and December 2025 were included. The index date was defined as the date of the current psychiatric admission, and all predictors were measured at or before that date. The outcome was a first CIGH event within 90 days, defined as paralytic ileus or intestinal obstruction, severe constipation requiring pharmacological intervention, or fecal impaction. Predictors were selected using LASSO regression, and the model was constructed with multivariable logistic regression. Performance was assessed using the area under the receiver operating characteristic curve (AUC), the calibration curve and decision curve analysis, and internal validation used 1,000 bootstrap resamples. Static and interactive (Shiny) nomograms were developed.Results: CIGH occurred in 356 of 1,426 patients (24.96%). Six predictors were retained: age ≥ 60 years (OR 1.469, 95% CI 1.031– 2.094), BMI < 24 kg/m2 (OR 1.699, 95% CI 1.099– 2.628), daily clozapine dose ≥ 300 mg (OR 2.276, 95% CI 1.531– 3.384), clozapine treatment duration ≥ 5 years (OR 2.309, 95% CI 1.431– 3.725), concomitant use of trihexyphenidyl (OR 3.322, 95% CI 2.291– 4.818) and predominantly bedridden status (OR 2.608, 95% CI 1.817– 3.744). Discrimination was moderate (AUC 0.731, 95% CI 0.694– 0.768; bootstrap-corrected AUC 0.718), calibration was acceptable, and decision curve analysis indicated net benefit across threshold probabilities of 15%– 70%.Conclusion: This internally validated model provides a non-invasive aid for stratifying 90-day CIGH risk in clozapine-treated psychiatric inpatients and for structuring gastrointestinal monitoring. External validation and prospective evaluation of clinical utility are required before routine implementation.Keywords: clozapine, gastrointestinal hypomotility, risk prediction model, mental disorders, nomogram, internal validation, retrospective cohort
Yuli Tang,1,* Lei Gao,2,* Qu Tang,1 Lin Wen31Department of General Logistics, Mental Health Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, People’s Republic of China; 2Department of Medical Equipment, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, People’s Republic of China; 3Mental Health Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lin Wen, Mental Health Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, Section 2, West 1st Ring Road, Qingyang District, Chengdu, Sichuan, People’s Republic of China, Tel +86 133 3094 2733, Email wenlinyxzb@med.uestc.edu.cnBackground: Diagnosis-related group (DRG)-based payment may change psychiatric inpatient service use through payer-to-provider settlement constraints and provider incentives. Evidence using contemporaneous fee-for-service comparison groups in psychiatric inpatient settings remains limited.Methods: We conducted a single-center retrospective controlled interrupted time-series study using 17,682 inpatient discharge settlement episodes from January 2022 to November 2025. The policy group entered DRG-based payment in January 2024; a contemporaneous fee-for-service group treated in the same hospital served as the comparison. Episode-level outcomes were aggregated into 94 group-month source units, and primary inference used segmented regression of 47 monthly policy-group minus comparison-group differences with Newey-West HAC standard errors.Results: The primary analysis estimated implementation-month relative decreases in total inpatient billing (− 29.10%; 95% CI, − 32.94% to − 25.04%) and length of stay (− 26.20%; 95% CI, − 29.99% to − 22.21%); case-mix-adjusted estimates were − 25.28% and − 25.33%. Five strictly positive billing components showed results consistent in direction and inference when modeled as ln(amount) rather than ln(amount + 1). The policy-group minus comparison-group difference in discharge not following medical advice increased by an estimated 5.82 percentage points (95% CI, 1.64 to 10.01), but the adjusted single-episode-patient sensitivity estimate was attenuated and less precise.Conclusion: In this single-center psychiatric inpatient setting, DRG implementation was accompanied by lower episode-level gross inpatient billing and shorter length of stay for the policy group relative to the contemporaneous fee-for-service comparison group. Discharge disposition remains an exploratory monitoring signal and was less robust in the adjusted single-episode sensitivity. These observational findings do not establish improved efficiency, quality of care, or long-term patient outcomes. For policy and hospital risk management, changes in billing and service duration should be interpreted alongside direct monitoring of quality and discharge outcomes.Keywords: diagnosis-related groups, controlled interrupted time series, psychiatric inpatients, inpatient billing, length of stay, discharge disposition
