OBJECTIVETo analyze the therapy of hypertensive outpatients among different grade hospitals in Beijing.

METHODSThirty-nine hospitals including 4 third grade hospitals, 4 second grade hospitals and 31 first grade hospitals in Beijing were selected randomly (by stratified randomization). The grade was accredited according to the hospital accreditation standard issued by Ministry of Health of the People's Republic of China.

RESULTSThe average hypertension control rate (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in outpatients was 32.3%. The hypertension control rate in the third grade, second grade, first grade hospitals were 37.7%, 36.9%, and 31.2% respectively. There was no difference in the control rate among the three different grade hospitals (P > 0.05). The frequency to use anti-hypertension drugs including long-acting calcium antagonism, ACEI, beta-receptor blocker in the third grade hospitals was significantly higher than those of the first and second grade hospitals. The rate of examination using ultrasonic cardiogram, CT, Holter and ambulatory blood pressure monitoring were significantly higher in the third grade hospitals than that of the first and second grade hospitals. There were significant differences in annual cost of hypertension treatment among three different grade hospitals (P < 0.01), being the highest (1567.5 yuan) in the third grade hospitals, medium (845.4 yuan) in the second grade hospitals, the lowest (651.8 yuan) in the first grade hospitals.

CONCLUSIONSSignificant difference in the cost of hypertensive treatment among three different grade hospitals exists in Beijing. However, there was no difference in the control rate among them. The overall hypertension control rate is 32.3%, leaving 67.7% uncontrolled. Efforts to increase the hypertension control rate should be made in all hospitals. How to guide and arrange the hypertension patients to consult a suitable hospital is important for rational and economical use of health cost.

China ; Hospitals ; statistics & numerical data ; Humans ; Hypertension ; drug therapy ; economics ; Outpatient Clinics, Hospital ; Surveys and Questionnaires

OBJECTIVETo estimate the effect of influenza-like illness (ILI) on outpatient visits and assess its impact on public health.

METHODSWe analyzed the data of weekly number of ILI and outpatient visits in Departments of Internal Medicine, Pediatrics and Emergency at two influenza surveillance hospitals during a period of 137 weeks in Guangzhou. Spectral analysis and time-series analysis were performed to evaluate the variation of outpatient visits over time. The predictive model was fitted with weekly outpatient visits as the dependent variable and weekly number of ILI as the independent variable. The optimal model was established according to the coefficient of determination, Akaike-information criterion and residual analysis. The validity of the model was assessed prospectively using the 31-week data that were not used for the model establishment.

RESULTSThe outpatient visits increased significantly over time and showed significant seasonality (P<0.001). A significant correlation was found between the weekly number of ILI and outpatient visits (r=0.568, P<0.001). The residuals of the fitted autoregression model were white-noise series and the coefficient of determination was 75% for the data used to establish the model and 56% for the subsequent 31-week data.

CONCLUSIONSThe autoregression model can be used to estimate the effect of weekly number of outpatient visits based on the weekly number of ILI and thus assess the effects of influenza on public health.

Child ; China ; epidemiology ; Emergency Service, Hospital ; statistics & numerical data ; Humans ; Influenza, Human ; epidemiology ; Logistic Models ; Outpatient Clinics, Hospital ; statistics & numerical data ; Outpatients ; statistics & numerical data

OBJECTIVETo investigate the variation patterns of the number of outpatient visits in hospitals to provide references for more effective management of general hospitals.

METHODSThe forecasting model of ARIMA(1,0,1)(0,1,1)12 was established using residual error analysis and least squares method according to the sequence stability, long-term trend and seasonal effect after logarithm transformation and differencing.

RESULTSThe residual sum of squares was 2.790, AIC=-178.126, SBC=-170.080. The relative predictive error of the model for predicting the outpatient visits in a general hospital in the year 2008 was 6.11%, smaller than that of exponential smoothing (8.78%). This model predicted a number of outpatient visits of 1,501,200 in this hospital in the year 2009.

CONCLUSIONSThe ARIMA model provides a means for predicting the number of total outpatient visits, its long-term tendency and seasonal variation. The parameters p,d,q in the ARIMA model may vary between different hospitals, and the ACF and PACF charts of the original sequences are helpful for determining these parameters.

China ; Forecasting ; Humans ; Models, Statistical ; Outpatient Clinics, Hospital ; statistics & numerical data ; Outpatients ; statistics & numerical data ; Patient Readmission ; statistics & numerical data ; Seasons

OBJECTIVETo assess the effects of ambient air pollutants on hospital outpatient visits for allergic disease and pollinosis.

METHODSThe monitoring data of daily air pollution (SO(2), NO(2) and PM(10)) in 8 national monitoring and controlling sites of Beijing air quality, airborne pollen in 4 monitoring sites of Beijing, and daily meteorological data, along with the daily numbers of outpatients visits for allergic disease and pollinosis at the Allergy Department of Beijing Shijitan Hospital from April to September in 2004 were collected. Associations between the levels of air pollutants and outpatient visits for allergic disease and pollinosis were estimated by time serial analysis using a generalized addictive model (GAM), considering lag effect and the influence of multipollutants.

RESULTSDuring the study period, the average daily ambient concentrations of SO(2), NO(2) and PM(10) were (20.9 ± 12.9), (58.6 ± 13.6) and (126.8 ± 64.1) µg/m(3), respectively. The mean daily pollen count was (163.8 ± 209.0) grains/1000 mm(2), while the average daily numbers of doctor visits for allergic disease and pollinosis were (16.3 ± 5.3) and (3.5 ± 5.0), respectively. Time serial analysis showed that significant positive associations were found between levels of airborne pollen and doctor visits, with an excess risk (ER) of 2.44% (95%CI: 0.75% - 4.13%)for allergic disease and 6.58% (95%CI: 3.82% - 9.34%) for pollinosis per 100 grains/1000 mm(2) increase in pollen, in single-pollutant models. There were associations between ambient air pollutants (SO(2), NO(2), PM(10)) and doctor visits with lag effects. A 10 µg/m(3) increase in NO(2) was associated with a 3.14% (95%CI: 0.42% - 5.85%) increase in doctor visits for allergic disease at lag 6 d. For pollinosis, the highest ER was observed for 10 µg/m(3) increases in SO(2) at lag 1 d, NO(2) at lag 6 d, PM(10) at lag 3 d. However, this association was not statistically significant (RR (95%CI) were 1.0460 (0.9640 - 1.1280), 1.0325 (0.9633 - 1.1017), 1.0079 (0.9942 - 1.0217), respectively). The associations enhanced slightly in multi-pollutant models with an ER of 2.56% (95%CI: 0.80% - 4.31%) for allergic disease and 6.81% (95%CI: 3.91% - 9.71%) for pollinosis per 100 grains/1000 mm(2) of pollen.

CONCLUSIONSOur results suggest that level of airborne pollen may have a stronger effect than ambient air pollutants on allergic disease and pollinosis.

Air Pollutants ; analysis ; Air Pollution ; analysis ; Environmental Illness ; prevention & control ; Environmental Monitoring ; Humans ; Outpatient Clinics, Hospital ; statistics & numerical data ; Rhinitis, Allergic, Seasonal ; prevention & control

This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
Chronic Disease/*economics/*epidemiology/therapy ; Comorbidity ; Delivery of Health Care/economics/utilization ; Health Care Costs/*statistics & numerical data ; Humans ; Outpatient Clinics, Hospital/*economics/*utilization ; Patient Admission/economics/statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; Unnecessary Procedures/*economics/*utilization ; Utilization Review

INTRODUCTIONThe objective of this study was to determine if patient information needs are being met and the level of patient satisfaction with rheumatology practitioners in participatory decision-making and thereby indirectly explore whether concordance was achieved.

MATERIALS AND METHODSThe design was a cross-sectional postal questionnaire survey of 420 patients attending outpatient clinics at the Norfolk and Norwich University Hospital who were taking disease modifying anti-rheumatic drugs (DMARDs) or a biological treatment. The population served is ethnically homogeneous and predominantly Caucasian.

RESULTSThe response rate was 76%. Most respondents (79%) had inflammatory arthritis while 66% had rheumatoid arthritis. Seventy-seven per cent of patients reported that the rationale behind commencing treatment was explained and that they were given ample opportunities to ask questions. Eighty-two per cent said they were given an appropriate amount of information. Sixty-four per cent of patients were satisfied with their level of participation in the decision-making process, although a substantial number (25%) said that information from different sources was conflicting. There was no correlation between concern about side effects and patients' perceptions of the effectiveness of medication. Females were more concerned than males about possible side effects; P =0.009, using the Mann-Whitney U test. One third of the patients altered their medication in response to whether their arthritis felt better or worse.

CONCLUSIONThe majority of patients were satisfied that their information needs were met and with the care provided in the practitioner clinic. Participatory decision-making was sub-optimal despite patient satisfaction with the amount of time allocated to meeting their information needs. We found that patients exercise autonomy in managing their arthritis by regulating their medications through an active decision-making process, which is informed by their previous experience of medication, and how well controlled they felt their arthritis was. Research into this decision-making process may hold the key to achieving concordance.

Antirheumatic Agents ; therapeutic use ; Arthritis ; drug therapy ; psychology ; Decision Making ; Female ; Health Care Surveys ; Humans ; Male ; Outpatient Clinics, Hospital ; Pain Measurement ; Patient Education as Topic ; standards ; Patient Participation ; Patient Satisfaction ; statistics & numerical data ; Rheumatology ; standards ; Singapore

AIMTo improve workflow and usability by introduction of a new electronic patient record (EPR) and database.

METHODSEstablishment of an EPR based on open source technology (MySQL database and PHP scripting language) in a tertiary care andrology center at a university clinic. Workflow analysis, a benchmark comparing the two systems and a survey for usability and ergonomics were carried out.

RESULTSWorkflow optimizations (electronic ordering of laboratory analysis, elimination of transcription steps and automated referral letters) and the decrease in time required for data entry per patient to 71%+/-27%, P<0.05, lead to a workload reduction. The benchmark showed a significant performance increase (highest with starting the respective system: 1.3+/-0.2 s vs. 11.1+/-0.2 s, mean+/-SD). In the survey, users rated the new system at least two ranks higher over its predecessor (P<0.01) in all sub-areas.

CONCLUSIONWith further improvements, today's EPR can evolve to substitute paper records, saving time (and possibly costs), supporting user satisfaction and expanding the basis for scientific evaluation when more data is electronically available. Newly introduced systems should be versatile, adaptable for users, and workflow-oriented to yield the highest benefit. If ready-made software is purchased, customization should be implemented during rollout.

Andrology ; organization & administration ; Benchmarking ; Databases as Topic ; standards ; Ergonomics ; Germany ; Hospitals, University ; Humans ; Male ; Medical Records Systems, Computerized ; standards ; Outpatient Clinics, Hospital ; organization & administration ; Systems Analysis ; User-Computer Interface ; Work Simplification ; Workload ; statistics & numerical data

Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.
Ambulatory Care/statistics & numerical data* ; Child ; Child, Preschool ; China/epidemiology* ; Cost of Illness ; Cough/virology* ; Female ; Fever/virology* ; Humans ; Infant ; Infant, Newborn ; Influenza A Virus, H1N1 Subtype ; Influenza A Virus, H3N2 Subtype ; Influenza, Human/epidemiology* ; Outpatient Clinics, Hospital/statistics & numerical data* ; Outpatients/statistics & numerical data* ; Prospective Studies ; Socioeconomic Factors ; Surveys and Questionnaires ; Virus Diseases

Adult ; Age Factors ; Ambulatory Care ; Appointments and Schedules ; Asian Continental Ancestry Group ; China ; Cohort Studies ; Diabetes Mellitus ; therapy ; Ethnic Groups ; statistics & numerical data ; European Continental Ancestry Group ; Female ; Humans ; India ; Logistic Models ; Malaysia ; Male ; Middle Aged ; Multivariate Analysis ; No-Show Patients ; statistics & numerical data ; Outpatient Clinics, Hospital ; ROC Curve ; Referral and Consultation ; Reminder Systems ; Retrospective Studies ; Seasons ; Sex Factors ; Singapore ; Text Messaging