The Different Classification of Hospitals Impact on the Equity of Medical Outcomes of Patients in China

Background: In the context of Healthy China Strategy, the traditional idea that large hospitals provide better medical care is still deeply rooted in people's minds. The characteristics of the medical inverted pyramid structure—higher-level medical institutions are overwhelmed, while lower-level medical institutions are deserted—have existed for a long time. Because of the unreasonable allocation of resources, it is difficult to meet the healthcare needs of citizens and to establish a tiered delivery system. The objective of this paper is to study the effect of different classification of hospitals (COH) on the equity of Medical Outcomes of patients.Methods: The data used was from Urban Employee Basic Medical Insurance (UEBMI) enrolment records of Chengdu. We conducted a retrospective study and used Nested Multinomial Logit Model (NMNL) to estimate the effect of COH on the equity of Medical Outcomes.Results: COH had a significant effect on the equity of Medical Outcomes, but the effectiveness and direction of the hospital level on different outcomes were not consistent. The reimbursement rate, medical expenditures, gender, age, disease type and others factors were associated with the effect(p<0.01); length of stay has a limited effect on health outcomes. It was not the case that the longer the hospital stay was, the higher the quality of care would be. When COH was distinguished, there were significant differences in the effect of different levels of hospitals on the equity of Medical Outcomes. Horizontally speaking, hospitals of the same level had different effects on different the equity of Medical Outcomes(p<0.01). From a longitudinal perspective, different levels of hospitals had different effects on the equity of Medical Outcomes(p<0.01). It was not the case that the higher the level of hospital, the better the medical outcome. When hospital levels and disease types were distinguished, the effect of hospitals of different levels on the medical outcome of different disease types was significantly different.Conclusions: COH made a difference in the equity of Medical Outcomes. Hospitals of different levels should be reasonably selected according to disease types to achieve the optimal medical outcome. Therefore, China should promote the construction of a tiered delivery system.

Machine Learning Evaluation of Biliary Atresia Patients to Predict Long-Term Outcome after the Kasai Procedure

Kasai portoenterostomy (KP) represents the first-line treatment for biliary atresia (BA). The purpose was to compare the accuracy of quantitative parameters extracted from laboratory tests, US imaging, and MR imaging studies using machine learning (ML) algorithms to predict the long-term medical outcome in native liver survivor BA patients after KP. Twenty-four patients were evaluated according to clinical and laboratory data at initial evaluation (median follow-up = 9.7 years) after KP as having ideal (n = 15) or non-ideal (n = 9) medical outcomes. Patients were re-evaluated after an additional 4 years and classified in group 1 (n = 12) as stable and group 2 (n = 12) as non-stable in the disease course. Laboratory and quantitative imaging parameters were merged to test ML algorithms. Total and direct bilirubin (TB and DB), as laboratory parameters, and US stiffness, as an imaging parameter, were the only statistically significant parameters between the groups. The best algorithm in terms of accuracy, sensitivity, specificity, and AUCROC was naive Bayes algorithm, selecting only laboratory parameters (TB and DB). This preliminary ML analysis confirms the fundamental role of TB and DB values in predicting the long-term medical outcome for BA patients after KP, even though their values may be within the normal range. Physicians should be alert when TB and DB values change slightly.

Impact of Length of Stay on both Financial Health and Medical Outcomes of Mission Hospitals in Rural Ghana

One of the major key clinical indicators of hospital performance is length of stay (LOS). This denominator is calculated in averages. The role of this measure could be dual (as medical outcome or financial health indicator). Regardless, it can also be observed as either positive or negative variable depending on how it is measured. By this study, LOS was assessed on both counts: as a measure of financial health and also as medical outcome of hospital. The investigator concludes, after thorough evaluation of available data, from both structured interviews and responses to a set of questions in a survey, that truly length of stay impacts positively on medical outcomes and also could be a measure of the financial healthiness of hospital.

Transforming electronic health record polysomnographic data into the Observational Medical Outcome Partnership's Common Data Model: a pilot feasibility study

Well-defined large-volume polysomnographic (PSG) data can identify subgroups and predict outcomes of obstructive sleep apnea (OSA). However, current PSG data are scattered across numerous sleep laboratories and have different formats in the electronic health record (EHR). Hence, this study aimed to convert EHR PSG into a standardized data format—the Observational Medical Outcome Partnership (OMOP) common data model (CDM). We extracted the PSG data of a university hospital for the period from 2004 to 2019. We designed and implemented an extract–transform–load (ETL) process to transform PSG data into the OMOP CDM format and verified the data quality through expert evaluation. We converted the data of 11,797 sleep studies into CDM and added 632,841 measurements and 9,535 observations to the existing CDM database. Among 86 PSG parameters, 20 were mapped to CDM standard vocabulary and 66 could not be mapped; thus, new custom standard concepts were created. We validated the conversion and usefulness of PSG data through patient-level prediction analyses for the CDM data. We believe that this study represents the first CDM conversion of PSG. In the future, CDM transformation will enable network research in sleep medicine and will contribute to presenting more relevant clinical evidence.

EFEKTIFITAS LATIHAN TERHADAP KUALITAS HIDUP LANSIA DENGAN OSTEOARTRITIS LUTUT DI KOTA MALANG

ABSTRAK Latar Belakang: Osteoartritis merupakan penyakit sendi yang memiliki ciri khas yaitu terjadinya degradasi tulang rawan sendi dan paling banyak menyerang pada individu dengan usia diatas 50 tahun. Osteoartritis menghasilkan rasa nyeri yang terjadi secara terus menerus, menurun hingga terbatasnya fungsi dan rendahnya kualitas hidup. Terapi non farmakologis yang disaran kan untuk penderita osteoartritis ialah exercise. Jenis exercise antara lain ROM Exercise, Strengthening Exercise, Aerobik exercise seperti forward walking atau retrowalking. Metode: Penelitian ini menggunakan desain Quasy Experimental dengan rancangan Pre Test dan Post Test bertujuan untuk mengidentifikasi Perbandingan Efektifitas Quadriceps Strengthening Exercise dan Retrowalking Exercise terhadap Kualitas Hidup Lansia dengan Osteoartritis lutut. populasi penelitian ini adalah Lansia yang berada di Posyandu RW 9 Kendal Kerep dengan sampel sejumlah 30responden yang dibagi menjadi 15 responden sebagai kelompok intervensi Quadriceps Strengthening Exercise dan 15 responden sebagai kelompok retrowalking exercise.Kualitas hidup terkait kesehatan diukur menggunakan kuesioner Medical Outcome Study Short Form-36 (SF-36).Data yang diperoleh dianalisa menggunkan independent t test. Hasil: Hasil penelitian denga Uji Independent T Testtest diperoleh nilai taraf signifikansi 0,000 sehingga diperoleh nilai (P<0,05), nilai sig. (2-tailed)< taraf nyata (α) sehingga hasil dari uji independent t test adalah Quadriceps strengthening exercise lebih efektif dibandingkan dengan retrowalking exercise terhadap peningkatan kualitas hidup lansia dengan osteoatritis lutut. Diskusi: Dalam penelitian ini nilai kualitas hidup kelompok quadriceps strengthening exercise lebih tinggi dibandingkan kelompok retrowalking exercise. Penelitian ini dapat dijadikan sebagi acuan untuk penelitian yang akan dilakukan di masa yang akan datang dengan memodifikasi intervensi. Rekomendasi penelitian ini yaitu intervensi quadriceps strengthening exercise dan retrowlaking exercise dapat diterapkan di pelayanan kesehatan, khususnya fisioterapi pada pasien dengan osteoartritis lutut.

Apoio social, funcionalidade familiar e controle glicêmico de pacientes diabéticos tipo 2

Objetivos: Avaliar a percepção de apoio social e funcionalidade familiar por pacientes com diabetes mellitus tipo 2 (DM2) atendidos no ambulatório de endocrinologia de um hospital universitário, assim como verificar associações com controle glicêmico e variáveis clínico-demográficas. Métodos: Estudo observacional e transversal, com entrevistas estruturadas com pacientes com DM2 em tratamento ambulatorial. O apoio social foi avaliado através da escala do Medical Outcome Study (MOS) e a funcionalidade familiar pelo Apgar de Família de Smilkstein. Resultados: Avaliaram-se 160 pacientes com média de idade de 55,7±11 anos, 76% mulheres e 54,4% da classe C. A percepção de apoio social foi positiva, sobretudo na dimensão afetiva, porém nos homens e idosos a dimensão material foi maior que nas mulheres (p=0,02). Houve diferença nesta percepção entre os pacientes com hiperglicemia e normoglicemia apenas na dimensão de informação (p=0,04). Funcionalidade familiar relacionou-se com idade (p=0,037) e sexo (p=0,02). Não se observou correlação entre apoio social e funcionalidade familiar com as variáveis tempo de diagnóstico, tipo de tratamento, índice de massa corporal, duração do acompanhamento, intervalos entre os retornos e classe econômica. Conclusões: A percepção de apoio social e funcionalidade familiar foi positiva, sobretudo entre os homens e os idosos, mas relacionou-se com glicemia apenas na dimensão de informação. É importante levar em conta sexo, idade, família e provimento de informação para oferecer aos pacientes diabéticos tipo 2 uma abordagem que lhes permita obter melhor enfrentamento da doença.