Objective To explore methods to develop a hospital quality of care index system of county level hospitals based on the homepage of inpatient medical records and examine the validity of this system. Methods By means of literature review, homepage data and panel discussion, along with theories and statistical methods, indexes were identified. The dimensions and indices of the index system were pinpointed. Confirmatory factor analysis and normalization methods were combined to calculate the weights and scores of such indices. Scores were adjusted by Charlson comorbidity index ( CCI) with multi-regression method. The hospitals were ranked by adjusted scores in each dimension. The validity was evaluated by comparing the application results to universally acknowledged standards, such as hospital level and economic level of the geographic areas. Results An index system with 6 dimensions and 25 indices was developed, and the application results proved valid to some extent. The adjustment of CCI also proved effective. The 6 dimensions were correlated yet their directions were not consistent. Conclusions The methods and data used to develop the system have demonstrated strong operability and availability. The application results can reflect medical care quality in different aspects making it applicable among homogeneous hospitals. It is meaningful to assess dimensions respectively.

Objective To explore diagnosis-related groups(DRGs) case mixes and development approaches for medicare expense standard fitting patients with respiratory system diseases in Sichuan province.Methods 280 717 cases of respiratory system diseases were sampled from the homepages of medical records of general hospitals in Sichuan.These cases were grouped by means of the exhaustive chi-square automatic interaction detector in the decision tree model and the medicare costs standard was derived using the relative-ratio weighting coefficient.Results The main classification nodes of respiratory diseases were age and patient clinical complexity level (PCCL).Patients were classified into 158 disease diagnosis related groups, including 122 DRGs of internal medicine and 36 DRGs in surgical medicine.The max relative-ratio weighting coefficient was 14.04 and the min one was 0.29.And the extreme inpatients' expenses can affect the identification of classification nodes, calculation of relative weighting coefficient and medicare cost standard.Conclusions Large sample size is advantageous in establishing DRGs and calculating the medicare costs standard based on relative-ratio weighting coefficient.It is however imperative to strengthen monitoring on extreme inpatients' costs and control the homepage quality of medical records.

Adopting self-designed questionnaires, the paper investigates medical information demands of clinicians in third-level hospitals, secondary-level hospitals and basic medical and health institutions in Sichuan province.The results show a higher demand for medical information services in Sichuan province, various continuing education and training service should be taken to meet the informa-tion demands of clinicians in different levels.

Objective To explore the effects of accumulated 60CD,γ-ray irradiation on small molecular metabolites in rats urine.Methods Ten healthy male SD rats were irradiated by 60Co γ-rays in 5 days and the accumulated doses were 0,0.2,0.4,0.6,0.8,1.0 Gy,respectively.The metabolites in urine of different groups were measured with 1 H-NMR combined with principal components analysis (PCA) and partial least square discriminate analysis (PLS-DA). Results The metabolites in rat urine were obviously changed after irradiation. Compared with control group,the amount of acetoacetate decreased after irradiation(t =29.7 -30.7,P ＜ 0.05 ),but its relative level was stable when the dose increased ( P ＞ 0.05 ).Meanwhile,the relative level of hippuric acid increased ( t =4.4 - 21.6,P ＜ 0.05 ) especially when the accumulated dose was higher than 1 Gy (t =21.6,P＜0.05). The relative level of proline,taurine and trimethylamine-N-oxide increased after irradiation with the same trend( t =3.5 - 13.4,4.7 - 11.5,2.9- 12.7,P＜0.05). Conclusions The acetoacetate,hippuric acid,proline,taurine,and trimethylamine-N-oxide may be applicable for biomarkers of accumulative irradiation on rat.

Objective To analyze the impact of canceling drug price markup policy on hospitalization expenses of urban public hospitals in Sichuan province and provide decision-making basis. Methods Data of hospitalization expenses of the top 50 diseases among inpatients discharged in 2016 and 2017 were collected, totaling 2 732 022 inpatient cases. Based on hospitalization expenses, these disease were divided into seven categories ( A-G) using dynamic clustering analysis, which represent respectively dominant diseases of different expense makeups, to compare such indicators as hospitalization expenses and composition ratios of these diseases before (2016) and after the reform (2017). Results The study found drastic changes among the medical expenses of different categories of dominant diseases. For example, per-hospitalization cost of categories E ( featuring high drug and examination expenses ) and G ( featuring balanced expenses distribution) diseases decreased since the reform, while the other categories rose instead. The proportion of drugs of different disease categories decreased to various extents. For example, category A ( high drug ratio of 5.60% ) and category E (5.15% ) diseases of which were found with the sharpest drop. Proportion of service expenses, on the other hand, rose to different extents. For example, the proportion of service expenses of all disease categories increased to varying degrees, among which category E (3.46% ), category F (3.37% ) and category D (3.36% ) accounted for the largest share of increase.Conclusions The reform is moving the cost structure of dominant diseases in Sichuan towards a rational level, yet with significant differences among disease categories. The authorities should target various categories to adjust their reimbursement policies, minimize financial burden on patients, strengthen their supervision on drug use and medical behavior, prevent such misbehaviors as the inducing demands and transferring drug markups.

Background: The "two-week visiting rate in those needing to visit" has been examined extensively as an important indicator of healthcare seeking behavior in China. Nevertheless, its relationship with health behaviors, such as physical activity, remains unknown. In addition, a significant difference exists between urban and rural Chinese people in terms of physical activity and healthcare seeking behavior. This study sought to investigate the relationship between physical activity and the two-week visiting rate by conducting a stratified analysis.Methods: The analysis included 5,801 participants aged above 15 years old. Multivariable logistic regression was applied to analyze the association after adjusting for possible confounding variables. Urban and rural differences were investigated using stratified analysis. Results: Adjusted estimates showed that those who were physically active were more likely to visit a healthcare facility, but only among the whole sample (adjusted odds ratio (AOR) = 1.45, 95％ confidence interval (CI): 1.26–1.66) and the rural sample (AOR = 1.56, 95％ CI: 1.21–2.01), and not among the urban sample. Conclusions: Educating people on physical activity may help in improving healthcare seeking behavior and vice versa. Additionally, health interventions may be tailored based on different settings.

Objective To evaluate the performance of medical services of 18 tertiary hospitals in Sichuan province in 2016 based on DRGs, to identify objective methods to evaluate service quality and performance of medical institutions.Methods Based on the homepage data of inpatient medical records from 18 tertiary hospitals in Sichuan in 2016, using diagnosis-related groups as a risk-adjustment tool, the study evaluated the medical service quality and performance from three dimensions:medical ability,service efficiency and medical Quality.Results In the evaluation of medical service capacity, hospital I had the highest number of discharged cases and total weight(83 405 cases and 126 522.22),and hospital G had the lowest discharge cases and total weight(2 350 cases,2 797.12).The highest number of DRGs group was from hospital B(661 groups),and the lowest from hospital G(43 groups).The highest value of CMI was from hospital F(2.091),and the lowest from hospital D(0.953).Hospitals B,I and P had wide disease type range,while hospitals F, B and I had higher overall technical level than the other hospitals.Of the service efficiency evaluation,hospital E had the lowest time consumption index(0.740),and hospital P had the lowest expenditure index(1.073).Of the service quality evaluation,hospitals F and G had the lowest risk of mortality and the lower risk of mortality(0.00%,0.00%).Hospital I had the highest total score (100.0 points), and hospital G had the lowest total score(51.1 points).Conclusions DRGs based evaluation on medical service quality and performance of medical institutions can ensure reliability and scientific adequacy of evaluation.It may contribute to the continuous improvement of medical quality, and provide data support and decision reference for medical service supervision.