ObjectiveTo systematically review the associations of cognitive frailty with mortality and hospitalization in the elderly. MethodsThe VIP, PubMed, CNKI, WanFang Data, CBM, Embase, Cochrane Library and Web of Science databases were electronically searched to collect cohort studies on the association of cognitive frailty with mortality or hospitalization in the elderly from inception to May, 2023. Two reviewers independently screened the literature, extracted data and assessed risk of bias of the included studies. Meta-analysis was performed by R 4.2.2 software. ResultsA total of 19 cohort studies involving 63 624 elderly were included. The results of meta-analysis showed that compared with healthy elder, the elder with cognitive frailty had a higher mortality (OR=2.75, 95%CI 2.10 to 3.59, P<0.01) and hospitalization (OR=1.67, 95%CI 1.40 to 2.00, P<0.01). Subgroup analysis showed that cognitive frailty was related to the risk of death in different status of frailty and cognitive function, different assessment tools, different countries of development, different follow-up time and research sites. At the same time, different status of frailty and cognitive function and different levels of development of countries were related to the risk of hospitalization. ConclusionCurrent evidence shows that cognitive frailty can increase the risk of hospitalization and mortality in the elderly. It is suggested that early screening and intervention of cognitive frailty should be carried out to effectively reduce the risk of adverse consequences, so as to achieve healthy aging.
Abstract Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center (SqC) in Gaoyou City of Jiangsu Province in 2010, so as to provide the baseline data of disease burden for further study. Methods The inpatient records of SqC in 2010 were collected. The first discharge diagnoses were classified according to the International Classification of Disease 10 (ICD-10). The general information of the inpatients, discharge diagnosis, hospitalization expenses, disease category, age, gender, and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients was 1036 in 2010, and the gender ratio was about 1.0 (50.7% vs. 49.3%); b) The disease spectrum included 17 categories. The cumulative percents of the top 5 systematic diseases were 81.2%, including the respiratory, digestive, neoplasm, circulatory diseases, and injury, poisoning amp; external causes; c) The top 15 diseases were pneumonia, fracture, malignant neoplasm, benign neoplasm, acute bronchitis, cerebral infarction, hypertension, acute appendicitis, emphysema, cholecystolithias accompanied with cholecystitis, inguinal hernia, coronary heart disease, diabetes mellitus, chronic bronchitis and superficial injury; d) The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5; e) The number of chronic diseases significantly increased with age, especially after the age of 35 years old, and reached the peak at the age over 65 years old; while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old. The average length of stay, the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones (13.8 days vs. 9.9 days, ? 3 082 vs. ? 2 615; ? 417 vs. ? 371, respectively); f)The length of stay and total hospitalization per capita were quite higher than the other township health centers (11.6 days vs. 5.2 days, ? 3 001.4 vs. ? 1 004.6); and g) Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses. Among the total reimbursement, the payment from New Cooperative Medical Scheme (NCMS) accounted for over 99%, while that from Medical Aid Scheme only accounted for less than 2%. Conclusion a) The top 3 systematic diseases of SqC are seen in respiratory system, digestive system and neoplasm. The acute diseases are mainly pneumonia and fracture; b) The number of acute or chronic diseases increases significantly with age, especially after 35 years old. Both adolescents and the aged suffer from the heaviest burden of diseases; c) The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers; and d) NCMS is the major source of reimbursement. However, the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy. Thus the policy of NCMS needs to be adjusted step by step in future.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
It's common that general rules exist in a certain classification. The general rules of expense classification enable us to judge the category of a patient as soon as possible and to curb the expense. Theory of rough set helps us reach the best reduction of attributes. Based on the core attributes, classification rules are put forward by value reduction. The results show that 10 core attributes remain in 21 attributes of 1527 inpatients' information and 76 classification rules are founded. All of 76 rules guide classification of the patients. 44 of the 76 rules define the only category of a patient, the other 32 rules defines the potential catagories of a patient. Meanwhile, equal attributes of the same category are summerized to guide the cost control of patients. The results indicate that the theory of rough set is effective in attributes reduction and rule generalization of patient expense classification, and it has important significance on medical practice.
ObjectiveTo compare and analyze the expenses of inpatients before and after the implementation of the adjustment plan for " abolition of the addition of drug expenses” (also called zero-addition of drug costs) in Sichuan Province, in order to provide a certain reference for understanding the effect of this reform policy and further optimizing the formulation.MethodsFrom the hospital information management system, the data of inpatients with gastric cancer in a tertiary general hospital in Sichuan Province from January to September 2016 (before implementation) and from January to September 2017 (after implementation) were collected and compared. The change in hospitalization expenses of relevant patients before and after the implementation of the adjustment plan for canceling the addition of drug expenses was analyzed.ResultsA total of 2 878 patients were included in the survey; from January to September 2016,1 453 patients were included, and from January to September 2017, 1 425 patients were included. Before and after the implementation of the policy, the median hospitalization expenses of patients with gastric cancer decreased from 7 331.31 yuan to 7 145.12 yuan, with a decrease of 2.54%; the median expenses of medicines decreased from 4 839.79yuan to 4 246.10 yuan, with an decrease of 12.27%; the median expenses of check and inspections increased from 740.00 yuan to 859.00 yuan, with an increase of 16.08%; the median expenses of treatment increased from 251.00 yuan to 424.00 yuan, with an increase of 68.92%; compared with the total expenses and drug expenses before implementation, the total expenses and drug expenses after implementation decreased significantly, while material expenses, treatment expenses, check and inspection expenses and other expenses increased somewhat (P<0.05); differences in radiotherapy expenses and surgical treatment expenses before and after the implementation of the policy were not statistically significant (P>0.05).ConclusionsAfter the implementation of the policy of " abolition of drug expenses addiction”, the total expenses is slightly reduced for the expenses composition of patients with gastric cancer. Through the strengthening of the internal operation and management of the hospital, the government should continually optimize the public medical institution. At the same time, the government should put the compensation mechanism in place and continuously improve the payment method of medical insurance to ensure that the medical value of medical personnel is respected and the medical needs of ordinary people are guaranteed.
Objective To understand the changing patterns and characteristics of the number of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before, during, and in the post-epidemic period of the COVID-19 pandemic and the Association between acute respiratory infections and hospitalization of patients with AECOPD. Methods A retrospective analysis was conducted to count the patients hospitalized for AECOPD in the Department of Respiratory Medicine of the Third Affiliated Hospital of Chongqing Medical University from July 2017 to June 2024. The pattern of change in the number of AECOPD hospitalizations and the associations with patients with respiratory tract infections in outpatient emergency departments were analyzed. Results During the COVID-19 epidemic, the number of hospitalizations of patients with AECOPD did not increase compared with the pre-epidemic period. Instead, it significantly decreased, especially in the winter and spring peaks (P<0.05). The only exception was a peak AECOPD hospitalization in the summer of 2022. COPD inpatient mortality and non-medical discharge rates tended to increase during the epidemic compared with the pre-epidemic period. Analysis of the curve of change in the number of patients with respiratory infections in our outpatient emergency departments during the same period revealed a downward trend in the number of patients with respiratory infections during the epidemic and an explosive increase in the number of patients with respiratory infections in the post epidemic period, whose average monthly number was more than twice as high as that during the epidemic. Correlation analysis of the number of patients with respiratory infections between AECOPD hospitalizations and outpatient emergency departments showed that there was a good correlation between the two in the pre-epidemic and post-epidemic periods, and the correlation between the two in the post-epidemic period was more significant in particular (r=0.84-0.91, P<0.001).In contrast, there was no significant correlation in 2021 and 2022 during the epidemic (r=0.24 and 0.50, P>0.05 ). The most common respiratory infection pathogens among AECOPD hospitalized patients during the post-epidemic period were influenza virus, COVID-19 virus, and human rhinovirus, respectively. Conclusions The pandemic period of COVID-19 infection did not show an increase in the number of AECOPD hospitalizations but rather a trend towards fewer hospitalizations. Respiratory infections were strongly associated with the number of AECOPD hospitalizations in the pre- and post-pandemic periods, while the correlation between the two was poorer during the pandemic period. Influenza virus was the most important respiratory infection pathogen for AECOPD during the post-epidemic period.
Objective To identify the chief factors influencing the hospitalization expenses in fracture patients with health insurance so as to provide information for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods A total of 113 fracture patients with medical insurance in a hospital of a certain city from September 2006 to April 2007 were included and statistical analysis was performed by using multinomial linear regression analysis. Results The major factors influencing the hospitalization expenses in fracture patients with health insurance included the proportion of material fees and drug fees, length of stay, performance of operations and blood transfusion and etc. Conclusion Lowering the proportion of material fees and drug fees reasonably, reducing the length of hospital stay and avoiding operations and blood transfusion were the key to the control of hospitalization expenses for fracture. It is imperative to speed up and deepen the reform in medical insurance system, formulate scientific diagnostic and treatment routines and clinical pathways as well as expense standards, and try out the payment on certain single disease such as fracture.
Objective To construct the prediction model of hospitalization expenses for ischemic heart disease, reveal the key factors affecting hospitalization expenses, and analyze the interaction between variables. Methods Patients from Sichuan medical insurance comprehensive service platform from January 2020 to December 2021 were extracted. The training set and test set were divided according to the ratio of 7∶3. Six machine learning models were constructed and trained by ten-fold cross validation, and was explained by SHAP theory. Results XGBoost model had the best performance among these models, with a R2 of 0.60, RMSE of 9 969.71 yuan, and MAE of 5 242.90 yuan in the test set. SHAP results showed that the five variables with the greatest impact on hospitalization expenses were surgery, length of stay, hospital grade, disease type and DRG. Hospitalization costs were higher when grade 3 or 4 procedures were performed, the length of stay was prolonged, the hospitalization was in a tertiary hospital, and payments were made for acute myocardial infarction and non-DRG. With the prolongation of hospital stay, the hospitalization expenses increased faster when the patient had grade 4 surgery and was in a tertiary hospital. In addition, DRG payment will reduce the length of hospital stay and the hospitalization expenses of patients with different disease types. Conclusion The interpretable XGBoost model constructed in this study has a good predictive performance for the hospitalization expenses of patients with ischemic heart disease. Combined with SHAP theory, it can effectively identify the key factors affecting the hospitalization expenses and analyze their interactions.
Objective To investigate financial burden of in-patients with hypothalamus-pituitary-adrenal gland/gonad diseases in the West China Hospital of Sichuan University, 2011, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: in 2011, 352 person-times of in-patients with hypothalamus-pituitary-adrenal gland/gonad disease as first diagnosis were hospitalized in the department of endocrinology and metabolism, of which, 139 were male and 213 were female, with mean age of 42.9±15.0 years; and b) median hospital stay was 11 days, the average cost of hospital stay for each patient was RMB 4 361.09 yuan, most of which was for lab tests, examination, and biomedicine cost. Conclusion Hypothalamus-pituitary-adrenal gland/gonad diseases are an important health problem in the department of endocrinology and metabolism in a Triple-A Hospital. Most of hospitalization costs are for lab tests, examination, and biomedicine cost.
Objective To systematically review the influence of frailty on the prognosis of non-cardiovascular surgery heart failure (HF) patients and to provide references for its prevention and management. Methods CNKI, VIP, CBM, WanFang Data, PubMed, EMbase, Web of Science, and The Cochrane Library were searched to collect cohort studies on the prognosis of non-cardiovascular surgery HF patients with frailty from inception to November 1st, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software. Results A total of 20 studies involving 11 127 patients were included. The results of meta-analysis showed that frailty increased the risk of all-cause mortality (HR=1.72, 95%CI 1.61 to 1.84, P<0.000 01), hospitalization (HR=2.06, 95%CI 1.26 to 3.37, P=0.004), and combined endpoint (HR=1.59, 95%CI 1.37 to 1.84, P<0.000 01) in non-cardiovascular surgery HF patients. Conclusion Current evidence shows that frailty can increase the risk of all-cause mortality, hospitalization, and combined endpoints in non-cardiovascular surgery HF patients. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.