Showing papers by "Tongji University published in 1969"

Exploring the transition to DRGs in Developing Countries: A case study in Shanghai, China.

Abstract: Objective With the success of DRGs (Diagnosis Related Groups) in developing countries, this prospective payment system has been imported into China from the early 21(st) century. However, DRGs has been struggling and has made little progress since (its adoption in) 2004. This study contributes to the debate on how to bridge the pay-for-service (system/scheme) and DRGs (Diagnosis Related Groups) during the transitional period of payment reform in China. Methods From 2008 to 2012, sixty regional general hospitals in Shanghai were divided into three groups according to their economic level, and one hospital was picked from each group randomly. After ranking of morbidity, 22130 patients with hypertension or coronary heart disease were chosen as sample. Using multiple linear regression analysis, the inter relationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay, region and economic level of the hospitals were examined. Results The main findings were (1) Age, LOS and the economic level of treatment location had a statistically significant impact on patients with hypertension or coronary heart disease. However, gender is only a significant factor to patients with coronary heart disease. The results suggested that age, LOS and the economic level of treatment location should be considered in formulating pricing standards for the hypertension patient group. Besides the above mentioned factors, gender should also be considered in formulating pricing standards for the coronary heart disease patient group. (2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases. Conclusion Simplification of the DRGs standard- setting process based on standardized clinical pathways and accurate costing will greatly increase the efficiency of implementing DRGs in the developing world.

The morphology of medial malleolus and its clinical relevance.

Abstract: Objective: To provide morphological data of medial malleolus to decrease the possibility of posterior tibial tendon injury and inadvertent ankle penetration. Methods: Computed tomography scans of the ankle in 215 patients were reviewed. Then parameters in the 3-D reconstruction images were measured by three independent, qualified observers on two separate occasions. Results: The average angle between tibia plafond and the articular facet of the medial malleolus was 55.88±4.11°. The distance from the most anterior point of the anterior colliculus to the center of the intercollicular groove was 11.68±1.13 mm. And the average angle between the bimalleolar axis and the articular facet of the medial malleolus was 76.61±2.04°. Significant differences were observed in the distance from the most anterior point of the anterior colliculus to the center of the intercollicular groove between males and females. (P < 0.05) All of the parameters exhibited moderate to excellent intra-class correlation coefficient (ICC). Conclusions: According to this study, the insertion angle is much smaller than previously believed, and adequate space only exists for two 4.0-mm screws in some large cases. The second screw will probably be near the posterior tibial tendon, especially in some small cases.

Cognitive dysfunction in type 2 diabetes patients accompanied with obstructive sleep apnea syndrome.

Abstract: OBJECTIVE To investigate cognitive dysfunction of type 2 diabetes patients accompanied with obstructive sleep apnea syndrome (OSAS), and to analyze its relevant characteristics. METHODS Total 115 type 2 diabetes patients were divided into OSAS group (O group, n=83) and non-OSAS group (N group, n=32); Physical examination patients (C1 group, n=64) and OSAS patients without diabetes (C2 group, n=47) served as the control group. Apnea-hypopnea index (AHI), nocturnal lowest saturation of pulse oxygen (LSPO2) and simple mental state examination scale (MMSE) were evaluated. RESULTS Among diabetes patients, patients with OSAS have lower glycated hemoglobin, platelet count, thrombocytocrit, MMSE score and lowest mean arterial oxygen than non-OSAS patients; cognitive dysfunction state and glycemic control of patients are related to their diabetic duration, and then along with increase of diabetic duration, glycemic control becomes poor, so that cognitive dysfunction becomes more and more obvious. CONCLUSION Along with increased diabetic duration in type 2 diabetes accompanied with OSAS, glycemic control becomes poor, so that cognitive dysfunction more easily occurs. Meanwhile, coagulation function of blood system in OSAS patients with diabetes is impacted to some extent.

How to Undertake Research of MHC Utilization in Under-developed Countries? A Case Study of MHC Utilization in Central and Western Rural China.

Abstract: SUMMARY Objective: This study was undertaken to address practical problems in maternal health care (MHC) utilization and conduct in-depth study of maternal health services utilization in underdeveloped countries(regions), thus to contribute to the achieving of the UN Millennium Development Goal 5. Data Collection: After searching and screening based on key words like “MHC” and “utilization”, we included 45 English articles and 106 Chinese articles from Pubmed, Medline, China Knowledge Resource Integrated and Wang Fang data base. The research themes, issues, designs, perspectives, dimensions and methods of these dissertations were analyzed. The development of MHC utilization research can be divided into three phases: Studies of the first phase focused primarily on decreasing MMR, which caused attention to the central and western rural areas maternal health services in China from domestic as well as international community; Studies of the second phase centered around the practical impacts of the implementation of MHC relevant programs and policy, confirming that the implementation of these programs and policies improved MHC service delivery and utilization, and promoted cooperation between researchers and practitioners; Studies of the third phase focused on the quality of MHC service utilization. We also found that the major problem in the current MHC service utilization is the huge gap across regions and the existing researches lack innovation and comparison researches between in different countries. Research themes of MHC services change regularly. We should grasp the characteristics and defects of current research to increase the innovation of future research and to better response to the problem solving, and thus to provide more valuable reference for the policy and practice of underdeveloped countries and areas.