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September 2017, Volume 20, No.25 Abstracts

 Comparative Study on the Performance Appraisal of the General Practice  between UK and China

WANG Yu1,2,3,ZHANG Xian-fu1,2,3,WU Xue-qian1,2,3,WU Hong-tao1,2,3,WANG Chun-ping1,2,3*,LYU Jun2,4

1.School of Public Health and Management,Weifang Medical University,Weifang 261053,China

2.Collaborative Innovation Center of Social Risks Governance in Health,Shanghai 200032,China

3."Health Shandong" Severe Social Risk Prevention and Management Synergy Innovation Center,Weifang 261053,China

4.School of Public Health,Fudan University,Shanghai 200032,China

*Corresponding author:WANG Chun-ping,Professor;E-mail:chpwang@163.com

    Abstract  The development and implementation of the performance appraisal for general practice in China are still at an early stage,while a stably scientific performance appraisal system which still needs to be learned from advanced experience abroad can improve the service quality and efficiency of general practitioners.In 2004,the United Kingdom introduced the quality and outcome framework(QOF) into the clinical payment and quality control system of general practice and developed a corresponding performance pay compensation mechanism.This study introduces and compares the content,index composition and main compensation mechanism of the performance appraisal system for general practice between China and the United Kingdom,and puts forward that China should establish a scientific and integrated performance appraisal mechanism to encourage multi-participant performance management and provide the flawless feedback and compensation mechanism in order to lay the foundation for the establishment of the performance appraisal mechanism for general practice in China.

    Key words  General practitioners;Performance appraisal;United Kingdom

 

Significance and Suggestions of Developing Functional Community Health Services in China

WANG Ting1,JIA Jian-guo2*

1.School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China

2.Xuanwu Hospital,Capital Medical University,Beijing 100053,China

*Corresponding author:JIA Jian-guo,Professor,Doctoral supervisor;E-mail:jiajianguo_1@126.com

    Abstract  People in functional community usually have a stable income and medical insurance with a certain homogeneity,which makes community health services are more suitable to them.However,they are also restricted by working hours with large mobility,which make it difficult for them to obtain continuous and accessible service in ordinary community health services.In addition,as core family members,people in functional community are usually under a lot of stress with severe mental and physical problems,so they have urgent needs for health services.At present,functional community health services in China are lack of social resources and complete services.And the difference between the functional community and the ordinary community is not clear.In order to realize the fairness of health services,functional community health services still need to be further developed in the government function which brings the social resources and improved in service contents to enhance their functionalities.The functional community health services also need the clear division of labor under the collaboration mode with universal coverage around the country.

    Key words  Functional community;Community health services

 

Status and Associated Factors of Lost to Follow-up in Community-based Chronic Disease Management

LI Lei1,WU Xiao-jing1,YAN Wen-jie2,QIN Jun-ru1,LIU Wei-wei1*

1.The Second Clinic of Peking University Third Hospital,Beijing 100191,China

2.Special Medical Services Department,Peking University International Hospital,Bejing 102206,China

*Corresponding author:LIU Wei-wei,Associate chief physician,Master supervisor;E-mail:c_lww@126.com

    Abstract  Objective  To investigate the status of lost to follow-up in community-based chronic disease management and to explore the possible associated factors,so as to offer a reference for reducing the rate of lost to follow-up.Methods  The enrolled participants were 1 008 cases of chronic disease comprising patients being followed up(follow-up group) and those lost to follow-up(lost to follow-up group) who received file establishment and chronic disease management services delivered by Yuxin Community Health Service Station located in Haidian District,Beijing from February 2016 to January 2017.By reviewing the files,we collected their sociodemographic characteristics.A face-to-face survey was conducted in the follow-up group and a telephone survey was carried out in the lost to follow up group with the Patient-Doctor Depth-of-Relationship Scale(PDDRS,Chinese version) for investigating the depth of patient-doctor relationship,and a self-developed Patient Satisfaction with the Medical Visit Questionnaire for investigating their satisfaction with the medical visit.And the lost to follow up group were surveyed about the reasons for lost to follow-up by telephone additionally.Results  Of the 1 008 cases,232 were lost to follow up with a rate of 23.0%.The rate of lost to follow-up significantly varied by age,employment status,educational attainment,methods for paying the medical expenses,number of diseases,and status of living with children(P0.05),but not by sex and marital status(P0.05).Two hundred and five in the follow-up group and 65 in the lost to follow-up group completed the survey.The two groups of participants had obvious differences in the total scores and item scores of PDDRS and level of satisfaction with the medical visit(P0.05).The main reasons for lost to follow-up were seeking medical care in other community health service institutions after moving47.7%(31/65)〕,changing the appointed community health service institution due to medical reimbursement 21.5%(14/65)〕,and preferring to seeking special or specialist outpatient services13.8%(9/65)〕.Conclusion  The rate of lost to follow-up in patients receiving community-based chronic disease management is slightly high and it is significantly associated with age over 65,in employment,low educational attainment,paying medical expenses on one's own,single disease,insufficient family support.In view of this,targeted appropriate measures should be taken and follow-up management should be enhanced in order to improve the quality and efficiency of community-based chronic disease management.

    Key words  Community health services;Chronic disease management;Lost to follow-up;Root cause analysis

 

Short-term Effect of Chronic Disease Patients with Long-term Prescription Policy on the Healthcare Quality of Contracted Patients and Policy Recommendations

LI Ting,LIN Qi-yi,HUANG Tao,YI Chun-tao*

Fenglin Community Health Service Center of Xuhui District,Shanghai 200030,China

*Corresponding author:YI Chun-tao,Chief physician;E-mail:yict@163.com

    Abstract  Objective  To observe the short-term effect of chronic disease patients with long-term prescription policy on the healthcare quality of contracted patients and further analyze the advantages and disadvantage of this policy in order to provide policy makers with policy recommendations.Methods  In February 2016,501 patients with hypertension/diabetes who contracted with family doctors were enrolled from the Fenglin  Community Health Service Center of Xuhui District as the intervention group.Using the convenience sampling approach,another 500 patients with similar disease were recruited by family doctors as the control group according to the age and gender in a 11 ratio.According to the chronic disease patients with long-term prescription policy,the intervention group was prescribed enough quantities and varieties of medicine at a time,that was the medicine should be enough to be taken for one to two months.The control group was prescribed according to the routine prescription policy,that was the amount of the single prescription should be enough for two weeks.After six months of intervention,a self-designed questionnaire was used to investigate hypertension /diabetes complications,the times of clinical visits to secondary class or top class hospitals due to hypertension /diabetes and its complications,the times of hospitalizations due to hypertension/diabetes and its complications and so on.A total of 1 001 questionnaires were distributed and all 1 001 questionnaires were retrieved.The effective recovery rate was 100.0%.Using the convenience sampling approach,the first eight patients who visited the family doctors in one day and seven community medical staff were selected to be interviewed as a focus group to collect their feedback on the chronic disease patients with long-term prescription policy.Results  During the intervention,there were no significant differences for both groups in the times of new occurring complication,the times of clinical visits to secondary class or top class hospitals due to hypertension /diabetes and its complications,and the times of hospitalizations due to hypertension/diabetes and its complications(P0.05).After six months of intervention,the interviews of contracted patients and family doctors indicated that the chronic disease patients with long-term prescription policy had no effect on the quality of healthcare.The advantage of the policy was that it brought more convenience to patients.The disadvantages of the policy were that the policy only covered few kinds of chronic diseases and was lack of incentive mechanism with some operational limitations.Conclusion  The chronic disease patients with long-term prescription policy has no effect on the healthcare quality of chronic disease patients in the short term.It is suggested that the policy should be further optimize to cover more chronic diseases and increase more incentive rules with operation convenience in order to become a useful attempt to build the reasonable hierarchical medical system.

    Key words  Chronic disease;Drug prescriptions;Healthcare quality;Community health services

 

Competencies of Grassroots General Practitioners in Jiangsu Province

LIU Hong1,SHI Wei-hong2,QIAO Xue-bin3*

1.School of Health Policy & Management,Nanjing Medical University,Nanjing 211166,China

2.School of Clinical Medicine,Jiangsu Vocational College of Medicine,Yancheng 224005,China

3.President's Office,Jiangsu Vocational College of Medicine,Yancheng 224005,China

*Corresponding author:QIAO Xue-binResearcher,Doctoral supervisor;E-mail:qiaoxb@njmu.edu.cn

    Abstract  Objective  To investigate the competencies of grassroots general practitioners(GPs) in Jiangsu Province,so as to provide an evidence for targeted improvement of the competencies of the primary healthcare providers.Methods  From July to August 2015,we purposively sampled 630 GPs from 23 township hospitals(community health service centers) and 41 village clinics(community health service stations) located in Jiangsu Province,China and surveyed them with a Self-rating Competencies Questionnaire for Grassroots General Practitioners in Jiangsu Province developed by our research team covering the demographic data and competencies(ability for delivering basic medical service,ability for delivering basic public health services,humanistic caring ability,professional spirit and literacy,and education and learning ability).The 608(497 from township hospitals and 111 from village clinics) returning responsive questionnaires were selected as the final participants,with a response rate of 96.5%.Results  Of the participants,64.1%(390/608) had never delivered mental health services,62.8%(382/608) offered rehabilitation services for 5 or less than 5 times,31.6%(192/608)were very familiar with/knew well the procedures for dealing with unexpected health emergencies,and 23.0%(140/608) were very familiar with/knew well the management for mental disorders.GPs from township hospitals were superior to those from village clinics in the level of mastery in management of common diseases/frequently occurring diseases,delivering family health assessment services and delivery times of rehabilitation services,but were inferior to those from village clinics in offering referral services and home-based diagnosis and treatment services(all P0.05).Compared with those from village clinics,GPs from township hospitals did inferior in the mastery level of management of mental disorders,providing follow-up services for the three groups(pregnant women,children and the elderly),and educating the young people of marriageable age with family planning,and they were complained more times within three years,but had better team collaboration(all P0.05).Township hospitals owned higher proportion of GPs who had worked in secondary/tertiary hospitals and possessed departments that those selected GPs from using more new diagnosis and treatment techniques in 2014 than village clinics(P0.05).GPs from township hospitals spent more time on self-study per week,and they were more familiar with searching the medical information from the internet,but had less training times for improving the professional and technical title/level of education compared with those from village clinics(all P0.05).Conclusion  The competencies of grassroots GPs in Jiangsu Province are unsatisfactory and unbalanced,which need to be improved urgently.

    Key words  General practitioners;Primary health care institutions;Post competency;Jiangsu

 

Community Awareness Level and Associated Factors of Hierarchical Diagnosis and Treatment System in Xuzhou

ZHAO Zhong-hui1,MIAO Chun-xia2,ZHUO Lang2,JIANG Jin-xing2,ZHENG Juan2,LI Han-han2,HUANG Wen-hao2,LI Qiu-su2,ZHAO Shi-hong2*

1.School of Public Health,Medical College of Soochow University,Suzhou 215006,China

2.The Research Centre of Health Policy and Health Management,Xuzhou Medical University,Xuzhou 221004,China

*Corresponding author:ZHAO Shi-hong,Professor,Master supervisor;E-mail:zhaosh@xzhmu.edu.cn

    Abstract  Objective  To investigate the community awareness level and associated factors of the hierarchical diagnosis and treatment system in Xuzhou,China,so as to provide some suggestions for the implementation and extension of the hierarchical diagnosis and treatment system.Methods  Seven hundred and fifty community residents were selected by stratified multistage random sampling from 3 subordinate counties(districts) of Xuzhou from July to August 2016.They were surveyed by a structured questionnaire designed by our research team covering demographic characteristics,and awareness of the hierarchical diagnosis and treatment system.The survey obtained a response rate of 94.7%(710/750).Results  Among the 710 community residents,349 knew the hierarchical diagnosis and treatment system,accounting for 49.2%.Most of them54.1%(189/349) knew it from newspapers,television,the internet and other media.The rate of the awareness of hierarchical diagnosis and treatment system obviously varied according to gender,age,education level,average monthly income and medical expenses of the previous year,self-perceived health status,time needed to go to the nearest community health service institution on foot,prevalence of chronic diseases,history of seeking medical services in grassroots healthcare institutions(P0.05),while it was not associated with occupation,marital status,type of medical insurance,and history of physical examination(P0.05).By multivariate Logistic regression analysis,the associated factors for the awareness level of hierarchical diagnosis and treatment system comprised of gender,education level,self-perceived health status,time needed to go to the nearest community health service institution on foot,and history of seeking diagnosis and treatment services in grassroots healthcare institutions(P0.05).Conclusion  It is necessary to improve the rate of awareness of hierarchical diagnosis and treatment system in community residents in Xuzhou.It is obviously associated with gender,education level,self-perceived health status,time needed to go to the nearest community health service institution on foot,and history of seeking medical services in grassroots healthcare institutions.Therefore,the health administrative departments should combine the new media,such as internet+,APP and public-service advertisement,and the old ones to publicize the knowledge of hierarchical diagnosis and treatment system,in order to direct residents to reasonably seek medical services.

    Key words  Hierarchical diagnosis and treatment system;Urban population;Awareness;Root cause analysis;Xuzhou

 

Awareness Level and Associated Factors of Hierarchical Diagnosis and Treatment System in Rural Residents in Xuzhou

LIU Shen-jun1,JIANG Jin-xing1,MIAO Chun-xia1,ZHUO Lang1,LI Han-han1,ZHENG Juan1,GAO Xing-qun2,LI Qiu-su1,ZHAO Shi-hong1*

1.The Research Centre of Health Policy and Health Management,Xuzhou Medical University,Xuzhou 221004,China

2.Department of Primary Health,Xuzhou Health and Family Planning Commission,Xuzhou 221004,China

*Corresponding author:ZHAO Shi-hong,Professor,Master supervisor;E-mail:zhaosh@xzhmu.edu.cn

    Abstract  Objective  To investigate the awareness level and associated factors of hierarchical diagnosis and treatment system in rural residents in Xuzhou,China.Methods  From July to August 2016,using stratified multistage random sampling,we selected 800 rural residents from 4 subordinate counties of Xuzhou,China and surveyed them by a questionnaire developed by our research team consisting of demographic characteristics and awareness of the hierarchical diagnosis and treatment system.The 763 returning responsive questionnaires were selected as the final participants,with a response rate of 95.4%.Results  Totaled 38.3%(292/763) rural residents knew the hierarchical diagnosis and treatment system.Newspapers,television,the internet and other media are the major ways from which they37.0%(108/292) obtained the knowledge about it.The rate of the awareness of hierarchical diagnosis and treatment system differed significantly by age,education level,occupation,average monthly income of the previous year,prevalence of disease in the two weeks before the survey,history of physical examination,history of seeking medical services in grassroots healthcare institutions,referral history(P0.05),but not by gender,marital status,type of medical insurance,self-perceived health and time needed to go to the nearest community health service institution on foot(P0.05).Multivariate Logistic regression analysis showed that,educational level,occupation,history of physical examination,history of seeking medical services in grassroots healthcare institutions and referral history were the influencing factors for the awareness level of hierarchical diagnosis and treatment system(P0.05).Conclusion  The rate of awareness of hierarchical diagnosis and treatment system in rural residents in Xuzhou needs to be raised.And it is influenced by educational level,occupation,history of physical examination,history of seeking medical services in grassroots healthcare institutions and referral history.

    Key words  Hierarchical diagnosis and treatment system;Rural populationAwareness;Root cause analysis;Xuzhou

 

Status and Associated Factors for Receiving First Contact Care Delivered by Community Health Institutions in Community Residents in Xuzhou During the Implementation of the Hierarchical Diagnosis and Treatment System

MIAO Chun-xia1,ZHUO Lang1,LI Han-han1,WANG Wen-hai2,JIANG Jin-xing1,ZHENG Juan1,HUANG Wen-hao1,LI Qiu-su1,ZHAO Shi-hong1*

1.The Research Centre of Health Policy and Health Management,Xuzhou Medical University,Xuzhou 221004,China

2.Health Emergency Response Office,Xuzhou Health and Family Planning Commission,Xuzhou 221004,China

*Corresponding author:ZHAO Shi-hong,Professor,Master supervisor;E-mail:zhaosh@xzhmu.edu.cn

    Abstract  Objective  To investigate the status and associated factors for receiving first contact care delivered by community health institutions in community residents in Xuzhou,China during the implementation of hierarchical diagnosis and treatment system,in order to provide some constructive suggestions for diverting patients reasonably,optimizing their health-seeking behavior and improving the role of the hierarchical diagnosis and treatment system.Methods  Seven hundred and fifty community residents were selected by stratified multistage random sampling in 3 subordinate counties(districts) of Xuzhou from July to August in 2016.They were surveyed by a structured questionnaire designed by our research team consisting of questions about demographic characteristics,awareness level of the hierarchical diagnosis and treatment system and the choice of medical treatment during the implementation of the hierarchical diagnosis and treatment system.The survey achieved a response rate of 94.7%(710/750).Results  Of the participants,86.5%(614/710) had a history of illness in 1 year,78.2% of them(480/614) sought medical services when they had an illness recently,and 53.1%(255/480) first received the care provided by community health service institutions.The rate of receiving first contact care delivered by community health service institutions varied significantly by education level,occupation,average monthly income and medical expenses of the preceding year,self-perceived health,prevalence of chronic diseases,and awareness level of the hierarchical diagnosis and treatment system(P0.05),but not by gender,age,marital status,and time needed to go to the nearest community health service institution on foot(P0.05).By multivariate Logistic regression analysis,the identified associated factors for seeking first contact care delivered by community health institutions in community residents consisted of education level,average monthly income and medical expenses of the preceding year,and awareness level of the hierarchical diagnosis and treatment system(P0.05).Conclusion  The rate of seeking medical services and that of receiving first contact care delivered by community health institutions in community residents in Xuzhou should be improved.Education level,average monthly income and medical expenses of the preceding year,and awareness level of the hierarchical diagnosis and treatment system are the associated factors for seeking first contact care delivered by community health institutions in these residents.

    Key words  Hierarchical diagnosis and treatment system;Urban population;First contact care in community;Root cause analysis;Xuzhou

 

An Eight-year Cohort Study of the Effect of the Joint Control on Cardiovascular Events and All-cause Mortality with Type 2 Diabetes Mellitus

ZHUANG Ning1ZHANG Jian-dong1WAN Gang2,GAO Li-juan1BIAN Chuan1CHEN Huai-ning1CHI qing1JIA Qiu-xiang1SU Yan-li1LIU Hai-qing1ZHANG Li-juan1LI Gui-ying1YAN Jun-sheng1XING Jia1FENG Yun-fei1XU Guo-qing1CUI Ya-li1ZHANG fan1XU Bao-zhen3,YANG Guang-Ran4*,YUAN Shen-Yuan4*

1.Chaoyang District Jingsong Community Health Service Center,Beijing 100021,China

2.Medical Record Statistics Room,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China

3.Department of Endocrinology,General Hospital of Beijing Military Region,Beijing 100700,China

4.Department of Endocrinology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China

*Corresponding author:YANG Guang-ran,Associate chief physician,Associate professor,Master supervisor;E-mail:yanggr_55@126.com

YUAN Shen-yuan,Chief physician,Professor,Master supervisor;E-mail:fulvic@126.com

    Abstract  Objective  To investigate the effect of the eight-year joint control on cardiovascular events and all-cause mortality with type 2 diabetes mellitus(T2DM).Methods  In the Beijing Community Diabetes Study(BCDS) project,441 patients with T2DM from Jinsong Community Health Service Center were enrolled from August to December in 2008 and followed up to September 2016.No case was drop-out.The patients were divided into the intensive management group(n=220) and the standard management group(n=221) through the random number table.The patients in two groups were regularly monitored by their family doctors with a one-to-one basis under the guidance of experts from first-class hospitals during the follow-up period.All the metabolic variables were detected,and the early detection and intervention of complications were carried out.The main differences in managements between two groups were the period of follow-up and the monitoring frequency of important indicators,including the indicators of glycosylated hemoglobin (HbA1c) and urinary albumin excretion rate(UAER).The patients in the intensive management group were followed up every 2 months,detected HbA1c every 3 months and detected UAER every 6 months,while the patients in the standard management group were followed up every 3 months,detected HbA1c every 6 months and detected UAER every 12 months.The related metabolic parameters between these two groups were compared from 2008 to 2016.The up to standard rate of joint control and the incidence of endpoint events were also compared at the same time to analyze the effect of the up to standard times of joint control on cardiovascular events and all-cause mortality.Results  The up to standard rate of FPG in the intensive management group was lower than that of the standard management group in 2012.The up to standard rate of FPG,HbA1c,LDL-C and joint control in the intensive management group were higher than that of the standard management group from 2015 to 2016.The up to standard rate of blood pressure in the intensive management group was higher than that of the standard management group in 2015.All these differences were statistically significant(P0.05).However,there were no significant differences between two groups in the incidence of all-cause deaths,cerebrovascular events,cardiovascular events,diabetic nephropathy,diabetic retinopathy,peripheral vascular events,tumor and total endpoint events(P0.05).A total of 139 patients(31.5%) were up to standard more than 3 times,while the rest of 302 patients(68.5%) were up to standard less than 3 times.The incidence of all-cause deaths,cardiovascular events and total endpoint events in patients who were up to standard more than 3 times was lower than that of patients who were up to standard less than 3 times(P0.05).The log-rank test showed that the cumulative risks of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times were significantly lower than that of patients who were up to standard less than 3 times(P0.05).The incidence of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times was lower than that of patients who were up to standard less than 3 times,and the difference was statistically significant in the sixth year of joint management(P0.05).Conclusion  The joint control model of community health service centers and first-class hospitals could effectively improve the reaching standard rate of joint control in patients with type 2 diabetes mellitus.The incidence of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times decreased significantly in the sixth year of joint control.

    Key words  Diabetes mellitus,type 2;Health management;Joint control rate;Cardiovascular event;All-cause mortality

 

1Perioperative Effect and Long-term Outcome of On-pump vs Off-pump Coronary Artery Bypass

HU Jia-xin*,RUAN Xin-min,LIN Yu

No.2 Cardiovascular Department,Daxuecheng Branch Hospital,Guangdong Provincial Hospital of TCM,Guangzhou 510105,China

*Corresponding author:HU Jia-xin,Associate chief physician,Associate professor;E-mail:1453386845@qq.com

    Abstract  Objective  To compare the perioperative effect and long-term outcome of on-pump coronary artery bypass(ONCAB) with those of off-pump coronary artery bypass(OPCAB).Methods  We obtained and compared the baseline data,perioperative data and follow-up data of 97 cases undergoing ONCAB(ONCAB group),and 150 cases undergoing OPCAB(OPCAB group) in No.2 Cardiovascular Department,Daxuecheng Branch Hospital,Guangdong Provincial Hospital of TCM from November 1998 to December 2009.Results  Compared with the patients in the ONCAB group,those in the OPCAB group were older,and they had lower incidence of left main coronary artery lesions(P0.05).Patients in the OPCAB group had less number of distal anastomosis,shorter duration of operation,shorter duration of mechanical ventilation,shorter length of stay in the ICU and shorter length of stay,and they used less dopamine,transfused less red blood cells and plasma postoperatively,as well as had less amount of postoperative drainage compared with those in the ONCAB group(P0.05).Two groups had no significant difference in the hospital mortality(P0.05).Of the 242 cases who survived during the perioperative period,71.1%(172) were followed up for over seven years,with a mean follow-up period of(11.6±2.5) years.Chest tightness/angina pectoris,ST-T wave changes/arrhythmia,graft occlusion were more likely to occur in patients with follow-up period of over seven years in OPCAB group than those in the ONCAB group(P0.05),but the mortality rates related to cardiac events and non-cardiac events,and overall mortality were similar in both groups(P0.05).Conclusion  Patients in the OPCAB group have much better surgical effect,but they have lower long-term patency rate due to more complicated techniques required by OPCAB,and higher recurrence of chest tightness/angina pectoris and incidence of myocardial ischemic changes.

    Key words  Coronary artery bypass,on-pump;Coronary artery bypass,off-pump;Perioperativeperiod;Prognosis

 

Clinical Manifestations and Serum Lipid Levels of Patients with Pulmonary Thromboembolism in Different Risk Stratification and the Influencing Factors of Risk Stratification

ZHAO Xiao-yu1,CHEN Ying-ying1,YE Mao-sheng1,WU sha2,ZHENG Rui1*

1.Department of Respiratory Internal Medicine,Shengjing Hospital of China Medical University,Shenyang 110022,China

2.Department of Critical Care Medicine,the 739 Hospital of Shenyang,Shenyang 110034,China

*Corresponding author:ZHENG Rui,Professor,Master supervisor;E-mail:zhengr@sj-hospital.org

    Abstract  Objective  To explore the clinical manifestations and serum lipid levels of patients with pulmonary thromboembolism (PTE) in different risk stratification and the influencing factors of risk stratification,in order to provide a rational treatment plan and preliminary diagnostic evidence for different risk stratified PTE.Methods  A total of 60 patients with PTE were enrolled from 2010 to 2014 in Shengjing Hospital of China Medical University in this study.According to the PTE risk classification standards proposed in the Guidelines on Diagnosis and Management of Acute Pulmonary Embolism which was developed by the European Society of Cardiology (ESC) in 2014,PTE patients were divided into high/medium risk PTE group(n=35) and low risk PTE group(n=25).The clinical data of two groups such as baseline information, clinical manifestations and serum lipid levels were collected and the baseline information was statistically analyzed through multivariate Logistic regression to explore the influencing factors of risk stratification.Results  The difference of age between two groups was statistically significant(P0.05).There were no significant differences in the proportion of male,smoking,alcohol consumption,hypertension,coronary heart disease,diabetes mellitus,cerebrovascular disease,deep venous thrombosis (DVT),recent surgery,trauma and long-term bed rest between two groups (P0.05).Age is the influencing factor of PTE risk stratificationOR=1.145,95%CI1.059,1.238,P0.05.There were significant differences in the incidence of palpitations,hemoptysis or blood-stained sputum,syncope and feeling impending death between two groups(P

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