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July 2013, Volume 16, No.19 Abstracts

 History and Present Situation of Development of General Practice in China

GE Yun-yun,XU Jing,ZHOU Ya-fu,et al.School of Health Policy & Management,Nanjing Medical University,Nanjing 210029,China

Abstract General practice,as a new trend of modern medical development,plays an important role for the development of medical cause.In order to sum up experiences and promote the development of general practice,this paper reviews the developing process and present situation of general practice in China,analyzes its existing problems,and thus puts forth some suggestions about its future development.

Key words General practice;General practitioners;History of development;Status

Establishment of Optimal Incentive Mechanism of Two-way Referral Based on Analytic Hierarchy Process

LEI Guang-he.School of Humanities and Management,Guangdong Medical College,Dongguan 523808,China

Abstract Objective To explore the optimal incentive mechanism of two-way referral so as to provide an evident for making decision in implementation of two-way referral incentive mechanism.

Methods By analyzing the main schemes and measures a multi-hierarchy evaluation model of incentive mechanism of two-way referral was set up.And then the weight values were determined by using expert judgment and analytic hierarchy process,and consistency check was conducted.

Results The multi-hierarchical structure was set up.The weight values of patients,community doctors and hospital doctors as the incentive subjects were respectively 0.2583,0.1047,and 0.6370.The weight values of healthcare reward and punishment,construction of community medical center,referral platform,and propaganda-communication as the incentive schemes were respectively 0.4950,0.3103,0.1164,and 0.0783.

Conclusion In implementation of two-way referral incentive,the first incentive subjects are hospital doctors,followed by patients;and the most effective incentive scheme is "healthcare reward and punishment",followed by "construction of community medical center".

Key words Two-way referral;Incentive mechanism;Analytic hierarchy process

Community Health Management and Service Practice for Floating Population

ZHONG Su-ya, ZHANG Ming-jun,YUAN Xiang-bo,et al.Community Health Service Center of Zhoushan Xincheng,Zhoushan 316021,China

Abstract Objective To investigate the effect of community heatlh management and service practice and build up community health service system for floating population,so as to meet the demands of the floating population,and provide a scientific basis for the government departments to formulate the relative policies and measures for floating population health service.

Methods In Zhoushan City "new healthy banks of residents" were established and "classified management and service" principle was carried out in implementation of health management programs for floating population,thus improving accessibility of health services and their health status.

Results The floating population were included in the scope of the basic public health services,promoting service equalization.Compared with 2010,in 2012 the rates of card establishment and full coverage of five kinds of vaccination for floating children increased by 1.67% and 8.33% respectively,the coverage rate of the childrens health by 2.44%,and systematic management rate by 0.04%.And "zero-death" in floating maternity women was achieved for consecutive 6 years under the condition of island.Compared with 2011,in 2012 the total awareness rate of basic health knowledge went up by 7.27%,and the developed rate of healthy behavior was raised by 1.53%.

Conclusion The enhancement of information management and healthcare service of floating population by policy guidance can help to promote the active utilization of community health services of the floating population,so as to improve the level of health.

Key words Community health services;Floating population;Delivery of health care

Demand and Supply of the Community Health Services in Four Districts of Shenzhen

QIU Min-mei,DANG Lu-xi,WANG Hong-rui,et al.Community Health Management Center of Fuyong Peoples Hospital in Baoan District,Shenzhen 518103,China

Abstract Objective To investigate the problems of community health service through analyzing the demand and supply of the services in community health centers(CHCs) of Baoan,Longgang,Futian,and Luohu districts in Shenzhen.

Methods Descriptive statistical method was used to analyze the served population,medical care,and public services of 437 CHCs of the four districts from 2008 to 2010.

Results From 2008 to 2010,the served population of Baoan CHCs was 3.16 and 2.59 times that of Futian District and Luohu District P0.01.Number of visits per capita at Emergency Room(ER) and Department of Traditional Chinese Medicine were bigger in Futian District and Luohu District than the other two districts.Baoan District had the highest person-times of ER visit and upward referral,and the largest difference of person-times between upward and downward referral.The health record coverage decreased by 19.39%-31.20% with Longgang district having the largest decrease.The person-time receiving hypertension and diabetes standard management was lower in Baoan District than that in Futian District and Luohu District P0.01.Conclusion The development of medical care and public health service in CHCs are unbalanced,and the situation was worse in Baoan District and Longgang District given their low accessibility.The management system should be improved and the financial support for the CHCs of Baoan and Longgang should be enhanced.

Key words Community health service centers;Labor;Traditional Chinese medicine service;Public health;Balance

Assessment on Cognition of Administrators in Rural Community Health Service Centers for Institutional Performance Evaluation in Wujiang City

CHEN Qiang, ZHOU Ya-fu,SHEN Guo-qiang,et al.School of Health Policy and Management, Nanjing Medical University,Nanjing 210029, China

Abstract Objective To understand the cognition of administrators in Rural Community Health Service CentersRCHSCsin Wujiang City for institutional performance evaluation.

Methods The questionnaire survey was conducted among the administrators of RCHSCs in Wujiang who were familial with performance evaluation in January of 2012.The collected data were analyzed by using SPSS 16.0 software.

Results There 83.3%95/114 of the administrators who held that the indexes of performance evaluation could reflect the amount of actual medical services, and the first two problems existing in the evaluation indexes were difficultly accurate measurement of the indexes and their complexity, with their total score of severity being 374 and 366 respectively. And there were 45.6%51/112 of the administrators who believed the difference in evaluation results among the RCHSCs was moderate,20.5%23/112 who believed the difference was small, and 33.9%38/112 who believed the difference was large, with a statistical difference between the first two and the thirdP0.01.The highest aspects of assessment in efficacy of performance evaluation was their promotion for public welfare, accounting for 65.2%73/112,and the top barrier influencing the implementation and role of performance evaluation was lack of long-term guarantee mechanism in government input, accounting for 75.4%86/114.

Conclusion The problems of difficultly accurate measurement of the indexes and their complexity are relatively serious. The present evaluation system could not avoid the disadvantage of "egalitarian practice" and "raising dawdler". It is necessary to improve the motivation mechanism on leaders of RCHSCs according to the scores of performance evaluation, and strengthen the compensation mechanism for RCHSCs so as to ensure a long-term and sustainable development. Key words Performance evaluationRural community health service centersTownship health centersCognition

Awareness of and Satisfaction about Two-way Referral among Residents in Beijing Suburb

LI Jin-liang,LI Shu-jun,SHAN Nan,et al.Yanqing County Hospital,Beijing 102100,China

Abstract Objective To explore the awareness of and satisfaction about two-way referral among residents in Beijing suburb.

Methods Questionnaire survey was conducted among patients treated in our hospital between December 2011 and September 2012.The awareness and satisfaction between patients with referral experience(n=180) and those without(n=118) was compared.Results Among the patients with referral experience,21.9%(39/178) would first seek treatment at community health organizations(CHOs),62.9%112/178 would seek hospital treatment,and 15.2%27/178 would conduct self-medication,which percentages were significantly different from those of patients without referral experience(12.8%,83.8%,and 3.4%)(χ2=16.768,P0.05.Channels of awareness of two-way referral were also different between the two groups of patients(χ2 = 102.300,74.912;P0.05.Confidence in timely treatment and satisfaction about therapeutic effects after referral were different between the two groups (χ2=219.800,36.880;P0.05.

Conclusion Patients who have experienced two-way referral are more likely to seek treatment at CHOs when they are not feeling well.Hospitals and CHOs are major sources of information about two-way referral.Patients have high level of satisfaction about the efficiency and efficacy of treatment after referral.Two-way referral system should be publicized and enhanced,and related standards and regulations should also be established.

Key words Community health services;Two-way referral;Cognition;Satisfaction

Survival Analysis of Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

SU Qing, ZHENG Yu-chun, ZHAO Bing, et al.Department of Respiratory Medicine, the First Peoples Hospital of Zhumadian City, Zhumadian 463000, China

Abstract Objective To evaluate the factors related to prognosis of patients with acute lung injuryALI and acute respiratory distress syndromeARDS,and to understand the survival conditions of patients at different risk grades.

Methods Retrospective analysis was performed on the data including age,sex and 30-day living status of 93 patients with ALI and ARDS from the First Peoples Hospital of Zhumadian City and the Central Hospital of Zhumadian City from January 2006 to January 2010.The t test, Logistic regression analysis, Cox proportional-hazard regression analysis and receiver operating characteristic curve analysis were used for statistical analysis.

Results Within 30 days the death cases were 6367.7%and the survival cases were 3032.3%.1The univariate analysis showed that the age, scores of acute physiology and chronic health evaluation (APACHE),the time of mechanical ventilation, blood urea nitrogen and serum creatinine of the death group were higher, and the oxygenation indexPaO2/FiO2 and pH value of blood were lower than those of the survival groupP0.05.The odds ratio( OR ) of death in patients with ARDS of pulmonary origin was 3.200 times that of the patients with ARDS of extrapulmonary origin. When 0-1 extrapulmonary organs dysfunction was used as the reference, the OR value of death for 3 or 4 and 5 extrapulmonary organs dysfunction were 4.333,9.333 and 14.667 respectively.2The multivariate Cox proportional-hazard regression analysis showed that 4 variables were enrolled into the model,including PaO2/FiO2 HR =0.511,APACHE scores HR =1.800,causes/inducement HR =1.958,and the number of dysfunctioned extrapulmonary organs HR =1.422.3Survival analysis using Kaplan-Meier methods showed that the 30-day survival rates in patients with PaO2/FiO2100 mm Hg,100-150 mm Hg and150 mm Hg were 13.3%4/30,29.0%9/31and 53.1%17/32,respectively,with significant differences among themP=0.000.The 30-day survival rates in patients with APACHE scores20,20-30 and 30 were 51.9%14/27, 32.4%12/37and 13.8%4/29,respectively,with significant differences among themP=0.001.The 30-day survival rates in patients with ARDS from pulmonary and extrappulmonary sources were 40.7%24/59 and 17.6%6/34,respectively,with significant differences between themP=0.003.The 30-day survival rates in patients with the number of dysfunctioned extrapulmonary organs1,or=2,3,4 and 5 were 57.1%12/21,40.7%11/27,23.5%4/17,12.5%2/16 and 8.3%1/12,respectively,with significant differences among themP=0.000.4By using the model for the prognostication of death established with 4 covariates of PaO2/FiO2,APACHEscores,causes/inducement and the number of dysfunctioned extrapulmonary organs,the area under the receiver operating characteristic curves was 0.84395%CI 0.760,0.926)〕,the sensitivity was 76.2%,the specificity was 80.0%,and the consistency was 77.42%,being better than any single factor in diagnostic efficacy.

Conclusion The mortality of ARDS is high in the hospital.The higher APACHE scores,pulmonary causes,extrapulmonary multiple organ dysfunction are the risk factors;while PaO2/FiO2 is the protective factors.The multivariate analysis in evaluating the prognosis of patients is better than the univariate analysis.

Key words Respiratory insufficiencyRespiratory distress syndrome,adultPrognosis;Survival analysis

Role of Sinus Heart Rate Turbulence in Risk Stratification of Patients with Acute Coronary Syndrome

LIN Xiao-ming.Department of Cardiology,the First Peoples Hospital of Foshan,Foshan 528000,China

Abstract Objective To evaluate the role of sinus heart rate turbulence(HRT) in risk stratification of patients with acute coronary syndrome(ACS).

Methods A total of 213 patients with ACS including 86 patients with acute myocardial infraction(AMI) and 127 patients with unstable angina pectoris(UAP),and 100 healthy controls were enrolled in this study.All subjects were measured with 24 h dynamic electrocardiogram and indicators of HRT were calculated.According to GRACE scoring,the ACS patients were further divided into 1ow-risk group,medium-risk group,and high-risk group.The indexes of HRT and incidence of abnormal HRT among the three groups were compared.

Results The AMI group and UAP group had significantly higher Turbulence onset(TO) and lower turbulence slope(TS) than the healthy control group P0.05.In AMI group and UAP group,high-risk subgroup had increased TO and decreased TS than the 1ow-risk group and medium-risk group P0.05.Incidence of abnormal HRT2 varied with risk stratification in AMI and UAP groups P0.05.The multivariate Cox regression analysis showed that TO and TS were the independent risk factors for cardiac sudden death.

Conclusion HRT may be a new indicator for ACS risk stratification.

Key words Sinus heart rate turbulence;Acute coronary syndrome;Risk stratification;Electrocardiography

Application of Logistic Regression and ROC Curve in Risk Prediction of Cerebral Infarction in Patients with Type 2 Diabetes Mellitus

YU Chang-chun.Information Department,No.101 Hospital of the PLA,Wuxi 214044,China

Abstract Objective To explore the feasibility of joint application of logistic regression and ROC curve in risk prediction of cerebral infarction in patients with type 2 diabetes mellitus in order to offer reference for adopting targeted preventive measures and working out therapeutic plans.

Methods Risk factors for cerebral infarction were obtained by logistic regression and the cutoff values were determined by ROC curve.The prediction and actual diagnosis were compared to assess the diagnostic value and accuracy of the model.

Results Three indexes which had significant effect on cerebral infarction were age,carotid artery intima-media thickness(CIMT),and carotid atherosclerotic plaque.Areas under curves(AUC) of age and CIMT were 0.836 and 0.849,respectively;cutoff values were 62.5 years and 0.93 mm,respectively.Two indicators sensitivity,specificity,and diagnostic accordance were 80.85%,73.81%,and 77.53%;80.85%,76.19%,and 78.65%.The sensitivity,specificity,and diagnostic accordance of the comprehensive prediction model was 87.23%,85.71%,and 86.52%,respectively.

Conclusion Joint application of logistic regression and ROC curve in risk prediction of cerebral infarction is feasible.Age and CIMT both have high diagnostic values in independent prediction of cerebral infarction.By contrast,the comprehensive logistic prediction model consisting of age,CIMT,and carotid atherosclerotic plaque is of more diagnostic value and prediction effect.

Key words Diabetes mellitus,type 2Cerebral infarctionLogistic regressionROC curve

Assessment Value of Plasma MMP-9 Level for Cardiac Function and Prognosis in Patients with Acute Non-ST Segment Elevation Myocardial Infarction and Diabetes Mellitus

LIU Zi-dong, FU Wei.Department of Cardiology of the Third Affiliated Hospital of Liaoning Medical College, Jinzhou 121000, China

Abstract Objective To investigate the correlation of the level of plasma matrix metalloproteinase 9MMP-9 with cardiac function and prognosis in elderly patients with acute non-ST segment elevation myocardial infarctionNSTEMI complicated with diabetes mellitus.

Methods Totally 108 elderly patients with NSTEMI and successfully underwent percutaneous coronary intervention(PCI) were divided as diabetic groupn=44

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