January 2013, Volume 16, No.1 Abstracts

Comparative Analysis of Community Health Comprehensive Reform of East,Middle and West China in Perspective of Medical Staff

ZHANG Yan-chun,QIN Jiang-mei,ZHANG Li-fang,et al.China National Health Development Research Centre,Beijing 100191,China

Abstract Objective To learn,from the viewpoint of medical staff,the changes of operation and satisfaction of community health services (CHS) as well as the recommendations for next step in different parts of China so as to facilitate CHS reform.

Methods According to geographical location and economic development level,12 CHS organizations from each of 8 cities were randomly chosen.A self reported questionnaire survey was conducted among the medical staffs.EpiData 3.0 was used for double entry and validation,and SPSS 17.0 software was taken for statistical analysis.

Results In terms of higher active working,lower applying ratio of anti-biotics,better social image and higher level of trust by residents,more medical staffs in the middle and west parts gave positive answers than those in the east part.In terms of primary effectiveness of the reform,performance evaluation,income and health insurance policies,the satisfaction levels of medical staffs in the middle and west parts were higher than those in the eastern part.As for recommendations for next step, medical staff in the east part focused on performance-based income; those in the east and middle parts emphasized increasing the categories of essential drugs; and those in the middle and west parts concerned more on basic facility construction and more training opportunity.

Conclusion In community health comprehensive reform the changes are better in the west and middle parts than in the east part. The basic facility construction should be further enhanced and more training opportunity needs to be given in the middle and west parts.The performance-based income reform needs to be emphasized in east part. Besides, it is necessary to improve the essential drug system and increase the categories of essential drugs.

Key words Community health services;Comprehensive reform;Health workers;Comparative study

A Tip Angle Analysis of Two-way Referral in Urban Community Health Service

WANG Ling-feng,LI Zhao-you.School of Humanities and Law of Northeastern University,Shenyang 110819,China

Abstract Objective To analyze the problem in "Two-way Referral" of urban community health service (CHS),in combination with successful experience abroad,so as to propose the suggestion for improvement of the "Two-way Referral" work and thus to promote the development of urban CHS.

Methods A questionnaire survey was conducted among residents sampled from five normative CHS centers to know their satisfaction degree on CHS work and to evaluate the situation of CHS work. The brainstorming and nominal group techniques were used to find out the difficulties in performance of "Two-way Referral",and then classification analysis was conducted by the tip angle analysis.

Results The satisfaction degrees of the residents on the State policy of CHS,CHS work, attitude, equipment, skills and accreditation were respectively 96.61%, 96.62%, 96.09%, 92.19%, 91.40%, 95.05%.And the satisfaction degree on State policy of CHS was positively linearly correlated with the satisfaction degrees on CHS work,attitude,equipment,skills and accreditation.By using the brainstorming and nominal group techniques 24 factors were determined for difficulties in performance of "Two-way Referral" work, and according to the tip angle analysis there were 3 apparent reasons,19 transition reasons and 2 fundamental reasons.

Conclusion The basic reasons for difficulties in performance of "Two-way Referral" are lack of strict "gatekeeper" system, non-clear mechanisms and no enough attention from the government. The key to resolve these problems are the design and improvement of the system, which the only way to completely resolve the problems.

Key words Community health services;Two-way referral;Tip angle analysis method

Establishment of An Urban Community Nursing Performance Appraisal System

PENG Xin,AN Li-bin,LI Wen-tao.School of Public Health and School of Nursing,Jilin University,Changchun 130021,China

Abstract Objective To establish an urban community nursing performance appraisal system from the perspective of input and output.

Methods Delphi method is used for two rounds of investigation among the experts.

Results Experts had relatively high authority and their views were in good accordance.Seven dimensions,17 items,and 23 indices were established for the system based on input and output.

Conclusion A new community nursing appraisal system is established and will promote the improvement of community nursing care.

Key words Community nursing;Performance evaluation;Urban community

Efficiencies of Community Health Service Systems in 14 Cities in Hunan Province

MAO Yan-na,LIU Li-hang,WANG Xiao-wan.Institute of Medical Information,Peking Union Medical College & Chinese Academy of Medical Sciences,Beijing 100730,China

Abstract Objective To evaluate the efficiency of community health service (CHS) systems among 14 cities in Hunan province,so as to provide information for decision making on improving the efficiency of CHS system.

Methods The data envelopment analysis (DEA) was used to analyze the data collected by performance evaluation survey of national primary public health service and statistic of health departments of Hunan in 2011.According to the combination of different input and output data,five DEA molds of evaluation were founded so as to evaluate the efficiencies of the CHS systems in the 14 cities from different from different aspects.

Results On the output of health service prospect,both mold 1 and mold 2 considered the CHS system of Hengyang city to be the effective decision making unit and the benchmark,but that of the Yiyang city to be ineffective.While on the social benefit prospect mold 3,mold 4 and mold 5 considered the CHS system of Yiyang city to be the effective.

Conclusion The pure technological efficiency needs to be improved more as compared with the scale efficiency,which is more significant to improve the function of "six in one" for community health service system.

Key words Community health services;Efficiency;Data envelopment analysis;Comparative study

Evaluation of Service Capacity of Urban CHCs in 11 Cities in Jiangxi Province

ZHOU Wei,WANG Wen-ying,YUAN Zhao-kang.Public Health School,Nanchang University,Nanchang 330006,China

Abstract Objective To evaluate the service capacity of urban CHCs in 11 cities in Jiangxi Province.

Methods TOPSIS method was used for the evaluation on the service capacity.

Results The Ci value of Pingxiang, Jian, Xinyu, Yichun, Nanchang, Jingdezhen, Ganzhou and Yingtan in 2010 was higher than that in 2007,while the Ci value of Fuzhou, Jiujiang and Shangrao in 2010 was lower than that in 2007.In 2007,cities of top three CHC service capacity were Fuzhou, Jiujiang and Shangrao, while Yingtan, Ganzhou and Jingdezhen ranked the last three.In 2010,cities of top three CHC service capacity were Jian, Pingxiang and Jingdezhen, while Yingtan, Fuzhou and Ganzhou were the last three.

Conclusion The service capacity of urban CHCs in Jiangxi Province has been enhanced in past years but still needs further improvement.

Key words Community health service centers;Service capacity;Comprehensive evaluation;TOPSIS

Traditional Chinese Medicine Service in Community Health Stations of Henan Province

XU Jing,XIE Shi-ping,DUAN Xiao-peng,et al.School of Humanities,Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China

Abstract Objective To analyze the provision of traditional Chinese medicine (TCM) service in community health stations (CHS) of Henan Province.

Methods Census data on 3 842 CHSs of Henan Province in 2010 were used for quantitative analysis.

Results About 60.70%2 332/3 842) of the CHSs were privately owned.Licenced TCM doctors accounted for 53.00% (2 582 /4 872) of all licenced doctors in CHSs,and 38.41% (2 997/7 803) of the medical staff in CHSs had TCM education background.TCM related equipment accounted for 14.36% (19 543.131/136 100.512) of the total value of medical equipment in CHSs.On average,each CHS had less than one set of the TCM equipment in the survey.Revenue from TCM accounted for 22.24% (72 261.834/324 946.900) of the total revenue.Outpatient volume of TCM accounted for 28.90% (8 280 050/28 652 185) of the total volume.The number of TCM prescription accounted for 44.29% (2 146 108/4 845 641) of the total prescription.

Conclusion Most of the CHSs in Henan Province are owned by private owners.TCM doctors account for a large proportion of the total doctors but the TCM equipment value accounts for a small proportion of the total medical equipment value.TCM has played an essential role in CHSs from perspectives of patient volume,number of prescription,and revenue.TCM equipment should be replenished to CHSs of Henan Province to further promote the utilization of TCM in CHSs.

Key words Community health service stations;Traditional Chinese medicine service;Henan Province

Study on the Compensation Mechanism for Zero-profit of Essential Drug in Community Health Service Institutions in Xian, Shaanxi Province

LIU Lu, YANG Shi-min, FANG Yu, et al.Xian Health Bureau, Xian 710007, China

Abstract Objective To investigate the compensation mechanism for zero-profit of essential drug in community health care institutes in Xian.

Methods A questionnaire was conducted for among a sample of randomly selected 7 out of 91 community health care institutes in Xian, Shanxi Province in July 2010.A semi-structured interview was also conducted to collect data related to drug revenue and expenditure.

Results 1Based on the survey results, the growth rate of average quantity of medical staff from 2007 to 2008 was 101.5%, from 2008 to 2009 was 95.2%, and the growth rate of average total drug varieties during the 3 years was 7.8%.2The calculation on the compensation for zero-profit of essential drugs showed that if each institution was compensated for 82 000 yuan, then a total of 7 462 000 yuan should be compensated to all the 91 health serice institutions.3Semi-structured interviews showed that community health service institutions not only conducted the initial diagnosis at the grassroots level, but also undertook various public health tasks.Given that there were many people, especially transient people in community, respondents from community health service institutions generally considered there were not enough personnel to meet the work requirements.

Conclusion The compensation mechanism for zero-profit of essential drugs is reasonable, but grass-root doctors worry about the insufficient compensation and the compensation mechanism.The government should increase the budget on community health service institutions and enhance the supervision on the various links of zero-profit compensation mechanism in order to promote the implementation of basic drug policies.

Key words Community health service institutionsEssential drugZero-profitCompensation mechanism

Predictive Value of SYNTAX Score and Global Risk Classification in Patients undergoing Percutaneous Coronary Intervention for Complicated Coronary Artery Disease

PENG Cheng,HE Ji-qiang,YU Xian-peng,et al.Department of Cardiology,Beijing Anzhen Hospital of the Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Disease,Beijing 100029,China

Abstract Objective To assess the value of SYNTAX score and Global Risk ClassificationGRCin predicting major adverse cardiac and cerebrovascular eventsMACCEamong patients with three-vessel and/or left-main coronary artery disease undergoing percutaneous coronary interventionPCIand furthermore compare the predictive ability between the two models.

Methods A total of 190 patients with three-vessel and/or left-main coronary artery disease undergoing PCI with Cypher-select drug-eluting stent in Cardiology Department of Beijing Anzhen Hospital between January 2007 to December 2008 were enrolled.SYNTAX score and GRC were retrospectively calculated according to the angiography result.The clinical endpoint focused on MACCE,including death,nonfatal myocardial infarction (MI),stroke,and repeat revascularization.Follow up was carried out by telephone or outpatient interview.The value of SYNTAX score and GRC to predict MACCE were studied respectively. Furthermore,area under the curve (AUC) was calculated to assess the difference between the predictive ablity of SYNTAX score and GRC.

Results MACCE rates of low,intermediate,and high tertiles according to SYNTAX score were 9.1%,16.2% and 30.9%,respectively. Both univariate analysis and multivariate analysis showed that SYNTAX score was the independent predictor of MACCEHR=2.15, 95%CI(1.30,3.54), P=0.003; HR=2.07, 95%CI(1.25,3.44), P=0.005. MACCE rates of low, intermediate,and high tertiles according to GRC were 17.8%,14.2% and 46.1%,respectively.Both univariate analysis and multivariate analysis showed that GRC was the independent predictor of MACCEHR=1.94, 95%CI (1.22,3.50), P=0.007; HR=1.94, 95%CI(1.15,3.27), P=0.013. AUC of SYNTAX score was 0.66795%CI(0.564,0.770), P=0.004,and AUC of GRC was 0.61795%CI (0.512,0.736), P=0.046.

Conclusion Both SYNTAX score and GRC could be independent risk predictors of MACCE among patients with three-vessel and/or left-main coronary artery disease undergoing PCI.GRC fail to show better predictive ability than SYNTAX score.

Key words SYNTAX score; Global risk classification; Percutaneous coronary intervention; Coronary artery disease; Major adverse cardiac and cerebrovascular events; Predictive

Long-term Prognosis of Young Patients with Acute Pulmonary Thromboembolism and the Influencing Factors

WANG Feng-rong, LIU Shuang.Department of Respiratory Medicine, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China

Abstract Objective To evaluate long-term outcomes of younger patients with acute pulmonary thromboembolism (PTE) and to determine its prognostic factors.

Methods The data of 81 acute PTE inpatients aged 44 or below from January 1997 to December in Anzhen hospital were collected.Follow-up was conducted through telephone or mail or clinic reexamination. The long-term unwanted clinical events were taken as the end point of observation and the factors impacting the long-term prognosis were analyzed.

Results Among the 81 patients 52 were male 64.2% and 29 female 35.8%.Histories of venous thromboemblism, recent trauma,fracture and operation as the common risk factor were found in 41 patients50.6% and 12 patients (14.8%).Autonomous PTE with undetermined causes was found in 3138.3%.The outcomes of these patients included good prognosis without obvious complications37, 45.7%,recurrent VTE5, 6.2%,post embolization syndrome29, 35.8%,chronic thromboembolic pulmonary hypertension4, 4.9%,and deaths6, 7.4%. Univariate analysis showed that histories of venous thromboemblism, spontaneous PTE and complication of deep venous thrombosis were associated with the occurrence of clinical events. Multivariate analysis revealed that prior thromboembolic diseases OR=0.342, 95%CI0.134, 0.876, P=0.025 and complication of deep venous thrombosis OR=0.347, 95%CI0.129, 0.923, P=0.036 were two independent risk factors for long-term outcomes of acute PTE.

Conclusion More than half of younger patients with acute PTE had chronic thrombotic events.More than 1/3 of the patients had no definite cause of PTE confirmed by univariate analysis as a factor affecting long-term prognosis,and prior thromboembolic diseases and complication of deep venous thrombosis were independent risk factors impacting the long-term prognosis.

Key words Pulmonary embolismThrombosisLong-term prognosisInfluencing factors

Effect of Intra-aortic Ballon Pump in Patients with Acute Anterior Myocardial Infarction after Unsuccessful Reperfusion Therapy on Serum Brain Natriuretic Peptide and Cardiac Function

FENG Chun-guang, YANG Xiang-jun, FU Qiang, et al.Department of Cardiology, the First Affiliated Hospital, Suzhou University, Suzhou 215006, China

Abstract Objective To evaluate the effectiveness and the safety of intra-aortic balloon pump (IABP) in patients with acute anterior myocardial infarction after unsuccessful reperfusion therapy and its effect on the concentration of serum brain natriuretic peptide (BNP) and the values of left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).

Methods Forty patients with acute anterior myocardial infarction,who underwent unsuccessful reperfusion therapy and optimal medication,were divided as IABP group (receiving IABP,n=20) and control group (not receiving IABP,n=20).At 1,7,90 days after admission the plasma concentration of BNP was measured by chemiluminescence immunoassay,and LVEDD and LVEF were measured by echocardiography.

Results On the 1st day of admission,there were no statistical difference between the two groups in values of BNP,LVEDD and LVEF.On the 7th day and the 90th day of admission,the values of BNP in the IABP group were lower than those in the control group 〔(692±153pg/ml vs.805±151pg/ml, P0.05;(587±191pg/ml vs. 722±174pg/ml, P0.05.On the 7th day of admission,no statistical difference was found between the two groups in values of LVEDD and LVEF (P0.05).On the 90th day of admission,the value of LVEDD in the IABP group were lower than those in the control group 〔(55±2mm vs. 58±3mm, P0.05,but in value of LVEF no statistical difference was found P0.05.

Conclusion On the basis of optimal medication,IABP can further lower the BNP level in patients with acute anterior myocardial infarction after unsuccessful reperfusion therapy,and improve their cardiac functions.

Key words Myocardial infarctionIntra-aortic balloon pumpBrain natriuretic peptideLeft ventricular end-diastolic diameterLeft ventricular ejection fraction

Assay of Carotid Elasticity in Patients with Chronic Obstructive Pulmonary Disease

YANG Chang, FENG Yan, WANG Xin-wei, et al.Department of Respiratory Medicine, Hubei Zhongshan Hospital, Wuhan 430030, China

Abstract Objective To determine relevant parameters of carotid elasticity in patients with chronic obstructive pulmonary diseaseCOPD.

Methods Totally 40 patients with COPD and 36 controls with normal pulmonary function were recruited.The clinical history was collected,and blood pressure,blood lipid,blood sugar and body mass index were measured for all the subjects.Parameters of carotid elasticity including beta stiffness index (β),arterial compliance (AC),augmentation index (AI),and one point pulse wave velocity (PWVβ) were determined by elastography tracking technique with ultrasound device.

Results Compared with the controls,COPD patients had significantly higher parameters in β value 〔(9.06±2.05 vs.7.65±2.13)〕, in PWVβ 〔(7.05±0.81m/s vs.6.22±0.90m/s,and in AI 〔(27.56±9.56% vs.20.01±5.56


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