This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

This paper uses the data collected from 138,477 patient discharge records of 37 Shanghai tertiary public hospitals in December 2013 and classifies all the records into different groups by using a localized diagnosis re-lated group tool.The coefficient of variation index ( CV) of each group was used to analyze the dispersion of average hospital cost per inpatient day for each group, in order to evaluate the suitability of diagnosis related group systems and to set the coefficients of difficulty ( relative weights) for each disease.The study has found that severity-based di-agnosis related group systems are more suitable and consistent.However, future studies should collect more detailed information on health costs in order to reflect the value of health professionals and technologies and therefore further improve diagnosis related classification and develop new systems that can be adapted to local conditions by applying the weights of different groups.

The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.

OBJECTIVETo evaluate objectively clinical effects of different needling methods on urethral syndrome.

METHODSEighty-nine cases of female urethral syndrome were randomly divided into an electroacupuncture group and a hand-acupuncture group. The scores were evaluated with I-PSS of International Urine-Controlled Association and life quality before and after treatment, and their therapeutic effects were compared.

RESULTSThe abnormal symptoms of urination alliviated in the both groups (P < 0.05); the short-term cured rate was 51.8% in the electroacupuncture group, which was higher than 17.1% in the hand-acupuncture group (P < 0.05).

CONCLUSIONThe therapeutic effect of electroacupuncture on female urethral syndrome is better than that of the hand-acupuncture.

Acupuncture Therapy ; Combined Modality Therapy ; Electroacupuncture ; Female ; Humans ; Quality of Life ; Syndrome

BACKGROUNDRandomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents (DES) implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease (CAD) in China.

METHODSFrom December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up: 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird. After two years of follow-up, there were 2176 patients (1245 Cypher, 558 Taxus and 373 Firebird). All patients were treated with aspirin and clopidogrel over at least 9 months.

RESULTSAmong 8190 patients, 17 patients had acute stent thrombosis (0.24%): 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis: 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%: 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%: 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%: 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up.

CONCLUSIONThe first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.

Acute Disease ; Angioplasty, Balloon, Coronary ; adverse effects ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Incidence ; Male ; Thrombosis ; etiology

BACKGROUNDWhether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear. Therefore, this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy.

METHODSTotal 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n = 230) or no FKB (n = 560) were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR).

RESULTSOverall, The prevalence of true bifurcation lesions, which included Medina classification (1,1,1), (1,0,1), or (0,1,1), was similar between-groups (non-FKB: 37.0% vs. FKB: 39.6%, P = 0.49). At mean 4 years follow-up, rates of major adverse cardiovascular events (non-FKB: 10.0% vs. FKB: 7.8%, P = 0.33), death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes.

CONCLUSIONSFor patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

BACKGROUNDPatients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population.

METHODSAmong a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF < 40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥ 40%. In-hospital and long-term outcomes were examined according to LVEF.

RESULTSThe estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P < 0.01; 10.30% vs. 1.33%, Log-rank test: P < 0.01, and 10.32% vs. 2.28%, Log-rank test: P < 0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P = 0.96). Using the Cox proportional hazard models, LVEF < 40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95%CI): 4.779 (2.369 - 9.637), 2.673 (1.353 - 5.282), and 1.827 (1.187 - 2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95%CI): 1.094 (0.558 - 2.147)).

CONCLUSIONAmong patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Disease ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Ventricular Function, Left ; physiology

BACKGROUNDAmong patients with advanced multivessel coronary disease, left ventricular (LV) function is widely variable, and clinical and angiographic correlates of ventricular dysfunction remain to be defined.

METHODSAmong 73 339 patients undergoing diagnostic cardiac catheterization at a single center in China, patients with left ventriculographic assessment were identified with three-vessel coronary disease with or without left main involvement. Clinical and angiographic characteristics were examined among patients with normal or varying extent of LV dysfunction, and predictors of LV impairment (ejection fraction (EF): < 25%, 25% - 40% or > 40%) were determined.

RESULTSAmong 11 950 patients identified with three-vessel coronary disease, the sample distribution of LVEF was > 40%, n = 10 776; 25% - 40%, n = 948; < 25%, n = 226. Patients with reduced LV function (< 40%) more commonly were male and had a history of myocardial infarction (MI), diabetes or unstable angina. Hypertension was more frequent in those with LVEF ≥ 40%. In a multivariate Logistic regression analysis, prior MI (odds ratio (OR), 3.37; 95% confidence interval (CI), 2.96 - 3.84) was most predictive of LVEF < 40%, followed by male gender, diabetes, and presentation with unstable angina. For LVEF < 25%, only prior MI was identified as a significant correlate of severe LV dysfunction (OR 4.06, 95%CI 3.06 - 5.39). Following exclusion of patients with previous MI (n = 7416), male gender and diabetes were predictive of LVEF < 40%, yet presentation with unstable angina was the only factor significantly associated with LVEF < 25%.

CONCLUSIONAmong individuals identified with three-vessel coronary disease with or without left main involvement, previous MI was the most significant risk factor of LV dysfunction.

Aged ; Coronary Angiography ; Coronary Disease ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; pathology ; physiopathology

BACKGROUNDLesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents (DES). Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies.

METHODSFrom April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy (213 male, (56.7 +/- 10.8) years old) and 247 using no crush strategy (206 male, (58.1 +/- 10.1) years old) were analyzed.

RESULTSThe follow-up period ranged from 237 to 1223 days, average (537 +/- 340) days for the crush group and (538 +/- 351) days for the no crush group. There was no significant difference of major adverse cardiac events (MACE) rate between the two groups (10.1% vs 12.1%; P = 0.481), nor in cardiac death, nonfatal myocardial infarction (MI) or in the target vessel revascularization (TVR) (0.4% vs 1.6%; P = 0.207, 2.7% vs 2.8; P = 1.000 and 7.0% vs 7.7%; P = 0.865). The stent thrombosis rate was similar in the two groups (1.6% vs 2.0%; P = 0.409), late and very late stent thrombosis in both groups were very low (0.4% vs 0.4%; P = 1.000). Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups (11.0% vs 13.5%; P = 0.786). During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention (PCI) in the first two years, which accounted for 47% of patients of all cases in four years.

CONCLUSIONCrush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons' skills are very important for reducing clinical events.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Angiography ; Coronary Artery Disease ; mortality ; pathology ; therapy ; Coronary Vessels ; pathology ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Survival Analysis ; Treatment Outcome

Objective To compare the effect of treating ostial left anterior descending artery (LAD)stenosis using drug-eluting stents(DES)by precisely positioning versus crossing over into left main (LM)technique.Methods From April 2004 to May 2006,DES implantations in 224 consecutive patients with ostial LAD lesions were performed by precisely positioning in 161 patients(P group)and crossing over into LM in 63 patients(C group).Clinical and angiographic follow-up was performed at 7 months post DES implantations.Results Relevant vessel diameter(RVD)was significantly larger(3.44±0.52 mm vs. 3.17±0.40 mm,P=0.039)and LM/LAD diameter ratio was significantly lower(1.16±0.07 vs.1.28± 0.05,P=0.000)in C group compared that in P group.Stent(3.53±0.31 mm vs.3.16±0.29 mm,P=0.035)and postdititation balloon(3.59±0.65 mm vs.3.24±0.32 mm,P=0.035)diameter were significantly larger and postdilitation(94.1%vs.29.5%,P=0.000)and kissing balloon(47.1%vs.15.2%,P=0.000)rates were significantly higher in P group than that in C group.Both groups achieved 100%Droeedure success rate.Major adverse cardiac events(MACE)rate(4.3%vs.1.6%,P=0.447),death(0 vs.0,P=1.000),AMI(1,2%vs.1.6%,P=1.000)and target vessel revascularization (TVR)rate(3.1%vs.0%,P=0.325)were similar between the 2 groups.One patient in P group developed subacute in-stent thrombosis.Follow-up angiography at 7 months showed that in-stent(0 vs.7.7%,P=0.316)and in-segment restenosis rate(3.8%vs.10.8%,P=0.431)tended to be lower while in-stent(0.12±0.08 mm vs.0.59±0.37 mm,P=0.000)and in-segment(0.17±0.09 mm vs.0.64±0.49 mm,P=0.000)late loss were significantly lower in C group compared with P group.Conclusion Compared with precisely positioning technique,crossing over into LM technique was more feasible and tended to reduce restenosis rate for ostial LAD lesions treated with DES.