Objective To analyze the characteristics of high hospitalization cost cases under DIP payment and put forward suggestions for management.Methods Data source was from DIP payment settlement results of a tertiary general hospital.Z-test and Chi-square test were used to analyze the differences between high hospitalization cost cases and normal hospitalization cost cases from three dimensions:difficulty of diagnosis and treatment,case enrollment in disease groups and medical cost structure index.Results From February to June 2023,there were 1,367 high hospitalization cost cases in sample hospitals,accounting for 4.72%of all DIP cases.Among the top five diseases,only the fifth was surgical disease.The high hospitalization cost cases caused by coding errors accounted for 20.6%.Among 12 indicators in three dimensions of difficulty of diagnosis and treatment,case enrollment in disease groups,and structure index of medical cost,there were statistical significance in difference between high hospitalization cost cases and normal hospitalization cost cases except the proportion of medical service income.Conclusions Cases with difficult diagnosis and treatment,high coding error rate,and unreasonable cost structure are more likely to have high hospitalization cost.It is necessary to pay attention to the quality of the first page of medical records,strengthen the supervision of diagnosis and treatment behaviors,develop differential specialists,formulate special assessment methods,establish and improve communication mechanisms,and improve supporting policies.

目的:分析医保支付方式改革下骨科医保患者住院费用中次均费用变动情况和各类费用对总费用的影响,为合理控制骨科患者的住院费用,提升医保基金使用效率提供理论依据.方法:选取某院骨科2019年—2022年6月参保患者7007名,采用CPI平减指数法和灰色关联法对住院费用进行分析,CPI平减指数法消除价格因素对费用产生的影响,灰色关联分析各类费用与总费用的关联程度.结果:2019年-2022年6月骨科参保患者住院费用次均费用呈先升后降趋势,同时材料占比趋势等同住院次均费用,药占比则相反.在灰色关联度分析中,材料费的关联度最高,其次是药品费和手术费.在灰色关联度分析中,材料费的关联度最高,其次是药品费和手术费.结论:骨科参保患者住院费用医保监管重点应为高值耗材,其次为合理用药和合理收费的监管.国家医用高值耗材带量采购政策的出台,也有助于降低骨科患者负担,提升市参保患者就医的获得感、幸福感和安全感.

目的 探讨支气管哮喘儿童体重指数(BMI)与肺功能、呼出气一氧化氮(FeNO)的关系.方法 选取 2020年 9月至 2022 年 9 月在扬州大学附属医院诊断为支气管哮喘的 114 例患儿作为研究对象,根据BMI将其分为肥胖组 47 例(41.2%)、超重组 24 例(21.1%)及体重正常组 43 例(37.7%).检测三组患儿治疗前的FeNO及肺功能指标,包括第 1 秒用力呼气容积(FEV1)、用力肺活量(FVC)、1 秒率(FEV1/FVC),呼气峰流速(PEF).结果 三组患儿的FVC、FEV1、FEV1/FVC比较,差异有统计学意义(P＜0.05);肥胖组患儿的FVC、FEV1、FEV1/FVC均低于体重正常组,差异有统计学意义(P＜0.05).三组患儿的PEF、FeNO比较,差异无统计学意义(P＞0.05).哮喘患儿BMI与FEV1、FEV1/FVC呈负相关(P＜0.05),与FeNO、FVC、PEF无相关性(P＞0.05).FeNO与肺功能指标无相关性(P＞0.05).结论 BMI可影响哮喘患儿肺功能的部分指标,与气道炎症指标无显著相关性.

目的:分析新冠肺炎疫情前后扬州市某三甲医院儿科住院患者收治量、次均费用、平均住院日及收治病种的变化.方法:统计该院2018年7月-2021年6月儿科住院患者数据,进行回顾性分析,分析疫情前后收治量、收治病种等变化.结果:2020年后,儿科出院患者人次显著低于疫情暴发前,降低13.3％;收治病种中呼吸道感染性疾病收治量占比较2020年前显著降低,降低24.49％;在平均住院日降低10.1％的情况下,次均费用增长6.5％.结论:新冠肺炎疫情后,人们生活方式和个人防护发生很大变化,儿科出院患者人次显著下降,一定程度上减轻了儿科医生工作量.互联网医院业务因其方便快捷、减少交叉感染,迎来空前发展机遇.医保管理部门要发挥好医保政策的经济杠杆作用,完善各项医保政策,以提高应对突发公共卫生事件的能力.

Objective:To investigate the value of video electroencephalogram (VEEG) combined with peripheral blood inflammation indicators [total number of white blood cells (WBC), hypersensitive C-reactive protein (hs-CRP), and procalcitonin (PCT)] in the diagnosis of brain injury in premature infants, and to provide new clinical ideas for the evaluation of brain injury and its short-term prognosis in premature infants.Methods:The premature infants who were admitted to Affiliated Hospital of Yangzhou University from October 2020 to July 2021 and premature infants who were born in the obstetric department of other hospitals in the city with high risk factors of brain injury and transferred to neonatal intensive care unit of Affiliated Hospital of Yangzhou University within 24 hours were selected. According to the results of head magnetic resonance imaging (MRI) at 40 weeks of corrected gestational age, the premature infants were divided into a brain injury group and a non-brain injury group, with 28 cases in each group. In the brain injury group, there were 16 males and 12 females, with a gestational age of (32.83±2.09) weeks; there were 13 males and 15 females in the non-brain injury group, with a gestational age of (32.79±2.14) weeks. All preterm infants were examined by bedside VEEG within 1 week after birth and 2 ml of venous blood was collected on the 1st, 3rd, and 7th day after birth to detect the levels of WBC, hs-CRP, and PCT. The sensitivity and specificity of VEEG in the diagnosis of brain injury in premature infants were analyzed by four-grid table of diagnostic test, and the differences of WBC, hs-CRP, and PCT levels between the two groups at different time points were analyzed by ANOVA for repeated measurement.Results:The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy of VEEG in the diagnosis of brain injury in premature infants were 78.6% (22/28), 82.1% (23/28), 81.5% (22/27), 79.3% (23/29), 4.4, 3.8, and 80.4% respectively, and the Kappa value was 0.607. On the 1st day after birth, there was no statistically significant difference in the hs-CRP level between the two groups ( P>0.05), the WBC and PCT levels in the brain injury group were higher than those in the non-brain injury group (both P<0.05). On the 3rd day after birth, the WBC, hs-CRP, and PCT levels in the brain injury group were higher than those in the non-brain injury group (all P<0.05). On the 7th day after birth, there were no statistically significant differences in the WBC and PCT levels between the two groups (both P>0.05), while the hs-CRP level was higher in the brain injury group ( P<0.05). Conclusions:VEEG can be used as a reliable basis for the early diagnosis of brain injury in premature infants. The simultaneous increase of WBC, hs-CRP, and PCT levels on the 3rd day after birth often indicates the risk of brain injury in premature infants.

Objective To recognize and treat the neonatal pulmonary hemorrhage early by exploring the risky factors of neonatal pulmonary hemorrhage.Methods The neonates with pulmonary hemorrhage treated at the NICU of our hospital from January,2005 to December,2018 were selected as a study group;the neonates with the same gestation and age treated at the NICU during the same period were selected according to the proportion of 1:2 as a control group.Both groups were retrospectively analyzed.The quantitative data were analyzed byx 2 test.The qualitative data were analyzed by multi-factor logistic regression models and coefficient of contingency analysis.Results There were 44 cases in the study group and 88 in the control group.The multi-factor analysis of the logistic regression showed that very low birth weight newborns,severe asphyxia,patent ductus arteriosus,Ⅲ-Ⅳ grade intracranial hemorrhages,blood transfusion,and small for gestational age of neonates were relevant to neonatal pulmonary hemorrhage,with statistical significance (all P ＜ 0.05).Conclusion Very low birth weight newborns,severe asphyxia,patent ductus arteriosus,Ⅲ-Ⅳ grade intracranial hemorrhages,blood transfusion,and small for gestational age of neonates are the risky factors of neonatal pulmonary hemorrhage.

目的 为缩短某院超长住院日,分析某三甲医院超长住院日患者分布特征与影响因素,为医院管理者决策提供参考.方法 从某三甲医院HIS系统中检索并整理出院日期为2013年1月1日-2017年12月31日共4062条超长住院患者病案首页信息,对住院天数、性别、年龄、出院科室、疾病诊断、住院费用、离院方式及转归等指标进行统计分析.结果 近5年超长住院日患者中男性比例高于女性患者,住院日31天～40天(57.31％),大于60岁以上的患者(57.19％)人数最多,出院科室排名前3位的分别为肿瘤科(17.78％)、骨科(12.79％)、普外科(11.85％).疾病诊断排前3位疾病名称分别为恶性肿瘤(18.93％)、与保健机构接触(17.82％)、损伤中毒和外因(14.48％).超长住院日患者的平均住院费用86952.81元,主要以医嘱离院(93.21％)、好转(72.77％)为主.以上因素经过假设检验,均有统计学意义(P<0.05).结论 医院应当加强对超长住院日患者影响因素的监测与管理,针对重点科室、病种、人群加强监管,合理配置医疗资源,缩短平均住院日,为提升医院的质量和效率提供指导.

目的 分析与探讨肺泡灌洗术对于治疗肺炎支原体患病小儿病症的临床效果.方法 资料选取的时间段为2014年1月~2016年12月,以在此期间于我院接受肺炎支原体肺炎治疗的小儿患者48例作为本次观察与研究的对象,按照随机划分的原则等分成对照组与实验观察组;其中对对照组患病小儿所采用的疗法是传统型治疗方式,对实验观察组则采用传统型治疗方式与肺泡灌洗术相结合的方式,对两组的临床效果进行统计学意义上的分析与探究.结果 在采取治疗的两天内,实验观察组患病小儿的二氧化碳分压指标占据了明显优势;因P<0.01,因此此结果具有统计学意义;且实验观察组的有效治疗率也呈现出显著优势,P<0.01,比较具有统计学意义.结论 肺泡灌洗术具有较强的临床推广意义和医学实践价值.

回顾性分析2015年1月至2016年12月期间我院住院的82例传染性单核细胞增多症患儿的临床资料,根据年龄(＜3岁、3～6岁、＞6岁)分组,分析各年龄组临床表现.结果发现,发热、颈部淋巴结肿大及皮疹的发生率各年龄组间无统计学差异(均P＞0.05);肝脾肿大及肝功能异常3组存在统计学差异(均P＜ 0.05);退热、扁桃体消退及淋巴结消退时间各年龄组无统计学差异(均P＞ 0.05).

目的 本文要探讨与研究的是具体医疗实践过程中对门诊小儿呼吸道感染患者的药学服务.方法 选取2014年1月到2016年12月我院接受治疗的门诊小儿呼吸道感染患者150例为研究对象,来观察、对比患者使用药物的真实情况、抗菌类药物的用药频度等指标.结果 本组患儿药物使用率为94.67%(142/150);本组患儿治疗过程中共采用了24种抗菌药物,头孢菌素类与青霉素类是主要构成部分;本组中的小儿呼吸道感染患者服用药物的种类多为单一或二联方式.结论 抗菌药物对门诊小儿呼吸道感染患者的病情具有较高的治疗率;药学服务人员应该通过自身的专业药学知识,为患者提供更好的药学服务,加强小儿呼吸道感染患者的药学服务管理工作,促进治疗效果的提高.

目的 研究儿童哮喘治疗中的呼出气一氧化氮测定的有效性.方法 选取2015年8月~2016年8月在我院接受治疗的哮喘儿童216例作为研究对象,将其随机分为实验组与对照组,各108例,以进行相关实验的统计与分析.采取定期随访的方式对所有哮喘病儿童患者进行调查(此前这些儿童已经接受了吸入糖皮质激素联合β-受体激动剂的治疗),时间长度为8个月,每两个月进行一次数据调查,对每个阶段中儿童的治疗及康复、病情复发情况进行统计,并制定统计图记录数据.对照组采用分级调整模式对哮喘的频率进行控制,实验组采取的是呼出气一氧化氮检测,是在对照组的基础上进行的.结果 实验组与对照组的患者在各项指标的对比下差异并不显著(P>0.05);而两个组别的儿童在吸入糖皮质激素的使用量方面却有着显著的差异,差异有统计学意义(P<0.05).结论 在治疗儿童哮喘病症中进行呼出气一氧化氮的测定对于吸入糖皮质激素是有利的,且可以在今后的治疗中起到理论和实践上的指导作用的.

目的：分析纤维支气管镜肺泡灌洗术治疗儿童社区获得性肺炎重症或难治性肺炎的疗效，探讨如何早期识别并及早进行纤支镜治疗的重要性。方法：2014年1月～2015年7月间，我科运用纤支镜肺泡灌洗术治疗难治性肺炎患儿46例，分析病例特点及镜下表现。结果：进行纤支镜肺泡灌洗的病例镜下均有气管支气管的黏膜炎症损伤；36例有较多分泌物，其性状与所感染病原体有关；痰栓形成者15例，气道炎性狭窄者9例，气道通气不良者24例。灌洗液细胞形态学检查异常。肺部病变26例患儿术后1周内明显吸收，17例患儿在7～14 d吸收，3例患儿在2周以上才吸收。结论：对于儿童难治性肺炎，纤支镜肺泡灌洗术能明显促进肺炎吸收，疗效好。如果早期即有明显的反复高热，常规治疗1周左右难以退热，X线检查无明显好转吸收者，提示常规治疗效果不好，应该尽早进行气管镜检查。

<正>病例患者女性,47岁,因"一过性视物模糊伴左侧肢体麻木50余天,反复言语不清20余天"为主诉于2012年11月20日入院。患者于入院前50余天安静状态下无明显诱因出现视物模糊,自认为是贫血所致,未在意,随后出现左侧偏身感觉麻木,走路不平衡,伴有右侧颈部牵拉痛引起头痛,症状持续存在,于2012年9月28日收入我院,行头磁共振成像(magnetic resonance imaging,MRI)和弥散加权成像(diffusion weighted imaging,DWI)及计算机断层摄影血管造影术(computed tomographic angiography,CTA)检查,诊断为脑梗死(病因不明确),予以改善循环、营养神经及抗

患者 男,17岁.因少语、少动、不食3d,于2012年8月23日来我院就诊.患者入院3d前患上呼吸道感染后逐渐出现少语,少动,不食,持续加重.1年前因类似情况住院,当时按病毒性脑炎给予抗病毒治疗,精神运动性抑制症状完全缓解出院.祖父有疑似精神病史.入院查体:体温38.7℃,体检欠配合,周身大汗,闭目、牙关紧闭,全身僵硬,四肢肌张力铅管样增高,巴氏征(-).精神检查:意识清晰,问话不答,表情呆滞,被动,违拗,拒食.