Objective To investigate the correlation between serum basic helix-loop-helix transcription fac-tor family member E40(BHLHE40)levels and subclinical atherosclerosis(SAS)in patients with type 2 dia-betes mellitus(T2DM).Methods A total of 145 T2DM patients admitted to the Department of General Prac-tice of Suzhou Municipal Hospital from January 2021 to January 2023 were selected as the study objects.Pa-tients were divided into SAS group(n=80)and non-SAS group(n=65)according to whether SAS occurred.Serum BHLHE40 level and clinical data of the two groups were compared.The correlation between serum BHLHE40 level and carotid intima media thickness(CIMT)was analyzed by Pearson correlation.The risk factors of SAS in T2DM patients were analyzed by multi-factor Logistic regression.The value of serum BHL-HE40 level in the diagnosis of SAS in T2DM patients was analyzed by receiver operating characteristic(ROC)curve.Results The age,duration of diabetes,low-density lipoprotein cholesterol(LDL-C),CIMT and serum BHLHE40 levels in SAS group were significantly higher than those in non-SAS group,with statistical differ-ence(P＜0.001).Correlation analysis showed that serum BHLHE40 level was positively correlated with CI-MT(r=0.671,P＜0.001).Multivariate Logistic regression analysis showed that duration of diabetes,age,CIMT,LDL-C and serum BHLHE40 level were all risk factors for SAS in T2DM patients(P＜0.05).ROC curve analysis indicated that the area under the curve(AUC)of serum BHLHE40 for the diagnosis of SAS in T2DM patients was 0.742,the sensitivity was 75.0％,and the specificity was 73.9％.Conclusion Serum BHLHE40 expression level is closely related to the occurrence of SAS in T2DM patients,and is of great diag-nostic value for the occurrence of SAS in T2DM patients.

Objective To investigate the clinical applicability and different characteristics of three commonly used diagnostic methods for drug-induced liver injury from the two aspects of liver injury induced by Western medicine and liver injury induced by traditional Chinese medicine. Methods A prospective cohort study was performed for 289 hospitalized patients with acute drug-induced liver injury who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2015 to December 2020 and did not receive integrated traditional Chinese and Western medicine therapy, among whom 187 patients had herb-induced liver injury and 102 had Western medicine-induced liver injury. The 289 patients were diagnosed by the integrated evidence chain (IEC), Roussel Uclaf Causality Assessment Method (RUCAM), and the Structured Expert Opinion Process (SEOP) method, and related data at acute onset were collected, including general information, latency period, detailed medication, and laboratory markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase, alkaline phosphatase, and total bilirubin. A statistical analysis was performed to investigate the consistency between IEC, RUCAM, and SEOP in the diagnosis of Western medicine-induced liver injury and herb-induced liver injury and their own applicability. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data; the chi-square was used for comparison of categorical data. Results The hepatocellular type was the main type of clinical liver injury in both Western medicine-induced liver injury and herb-induced liver injury, accounting for 81.4% and 74.3%, respectively, and laboratory examination showed higher levels of ALT and AST. Western medicine-induced liver injury cases were diagnosed by IEC, RUCAM, and SEOP, with a clinical diagnosis rate of 65.7%, 100%, and 63.7%, respectively, and the constituent ratio of Western medicine-induced liver injury was 23.2%, 35.3%, and 22.5%, respectively. Herb-induced liver injury cases were diagnosed by these three methods, with a clinical diagnosis rate of 47.6%, 100%, and 29.9%, respectively, and the constituent ratio of herb-induced liver injury was 30.8%, 64.7%, and 19.4%, respectively. The consistency test of the three diagnostic methods showed that in the diagnosis of Western medicine-induced liver injury cases, there was good consistency between IEC and SEOP (Kappa=0.785, P < 0.05), while there was poor consistency between RUCAM and IEC (Kappa=0.149, P > 0.05) and between RUCAM and SEOP (Kappa=0.117, P > 0.05); in the diagnosis of herb-induced liver injury cases, there was poor consistency between RUCAM and SEOP (Kappa=0.066, P > 0.05), while there was good consistency between RUCAM and IEC (Kappa=0.026, P < 0.05) and between IEC and SEOP (Kappa=0.437, P < 0.05). Conclusion The IEC method shows good applicability for both Western medicine-induced liver injury and herb-induced liver injury, and there is good consistency between IEC and SEOP in the diagnosis of Western medicine-induced liver injury cases, while there is a relatively low level of consistency between IEC and SEOP in the diagnosis of herb-induced liver injury. There is poor consistency between RUCAM and the other two methods. In the clinical diagnosis of Western medicine-induced liver injury, IEC, RUCAM, and SEOP should be used in combination to accurately judge the causal relationship between drugs and liver injury.

Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents ( for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.

Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures.

Objective To evaluate the impacts of DRGs payment reform on patients, medical insurance fund and hospitals, then to steadily promote the payment reform. Methods The reimbursement data of inpatients covered by NCMS yet beyond the single-disease payment were collected from two DRGs pilot hospitals from January 2016 to June 2018. Such means as descriptive statistics, t test and method of interrupted time series analysis were used to compare the changes found in the average out-of-pocket payment, actual reimbursement rate, average per-hospitalization compensation, average length of stay, and average hospitalization expense before and after the DRGs payment reform. Results After the reform, the average out-of-pocket payment and average length of stay began to fall slightly instead of the increasing trend (β3 were -72.79,-0.11, respectively, and P<0.01), the upward trend of average hospitalization expense slowed down ( β3 was -113. 55, and P<0.01), actual reimbursement rate and the average per-hospitalization compensation stayed the original growth trend (β3 were 0.10,-31.15, respectively, and P values were 0.08, 0.09, respectively). Conclusions DRGs encourages the hospitals to curb the average hospitalization expenses, with the growth trend kept at a slower pace. The payment reform does not increase the financial burden of patients, and tends to ease such pressure on funds, but the long-term effect remains to be seen.

Objective To learn the behaviorist changes of county and township hospitals in their care of the diseases categorized in the hierarchical system before and after the system was in place. Methods Descriptive statistics and correlation analysis were used to analyze the changes of the diseases categorized in the hierarchical system which were cared at both county and township levels. Results The inpatients coverage of such diseases in county W in the western region at county and township hospitals was 44. 97%and 59. 28% respectively. These data were higher than that in county F in the eastern region, which were 18. 32% and 15. 58% respectively. As discovered in the Spearmen rank correlation analysis, the inpatients growth of diseases under the hierarchical system of counties F and W in 2015 was positively correlated to the difference between the pricing for the disease in question and the average hospitalization fee for the same disease in 2014 (r=0. 462, P<0. 001;r=0. 304, P=0. 018 ). In county W where the quota payment of specific diseases was in place, the increase of the average cost per hospitalization in 2015 was positively correlated to the above mentioned difference in 2014 and 2015(r=0. 447, P<0. 001). Conclusions The coverage of such diseases should be expanded. Changes in the pricing for such diseases will influence inpatients flow, while quota payment per disease can curb the increase of costs per hospitalization.

Objective To analyze the operation of the diagnosis-related groups ( DRGs) pilots for inpatients in the new rural cooperative medical system in Yulin city of Shaanxi province. Methods The medical records of 33306 inpatients discharged from the 3 pilot hospitals between January and July in 2017 were analyzed, aided by expert discussions, on-site assessment and medical records examinations. Results By the end of July 2017, the DRGs grouping tool had been running stably. The DRGs enrollment rates of discharged inpatients were all up to 99% in the 3 pilot hospitals. The coefficient of variation ( CV) was higher than 1 only in a few DRGs. The average length of stay and the average hospitalization expenses growth rate were both found declined. However, there also exist problems in the pilots, namely incomplete regulations for DRGs, low clinical path coverage rate, hysteretic supervision and assessment, uneven quality of medical records management and so on. Conclusions The pilots operated smoothly as evidenced in their initial success. Yet the following recommendations were raised for the improvements: To strengthen the organization and leadership to improve the DRGs related supporting system in pilot hospitals; To strengthen the promotion and application of clinical paths for standardization of the medical service process;To improve the DRGs assessment program and establish DRGs operation monitoring and tracking analysis system; To strengthen the training of medical record coding staff to improve continuously the quality of medical records.

To achieve the goal of universal healthcare coverage,and the objective of the ongoing healthcare reform to establish an essential healthcare system,the study proposed a financial framework for building the essential medical service package,covering medical services offered by primary medical institutions,treatment of major diseases,and essential medical services offered by secondary and tertiary hospitals.With data over the years of the total medical expense and medical service usage as the basis,and in the principles of affordability and cost-effectiveness,the total financing quota of essential medical services is expected to reach 1 940.846-2 1 62.41 7 billion,accounting for 30.66%-34.1 6% of the total healthcare expenditure.75% of the financing load should be carried by the government and society, focusing on financing medical services offered by primary institutions and lowering out-of-pocket burden of residents.

Objective To divide the medical services currently offered by various medical institutions into priority,extended and non-essential items.Methods The items were divided according to their actual usage at these hospitals,and such services were screened based on hospital positioning and clinical pathway of diseases.Results The selected priority services at the primary,secondary and tertiary hospitals were 255, 378 and 820 respectively.Their proportions in total medical services of these hospitals were 92.9%,95.9% and 97.4% respectively,and the proportion of their costs in total medical service costs were 57.9%,76.8% and 84.5% respectively.Conclusions The selected priority items had covered most of the services and costs,which deserve promotions at all the hospitals as it embodied the principle of benefiting the majority of the population.

Objective To determine the main contents and key points of the essential medical services by means of priority setting of diseases with high incidence and serious damage based on the demand of residential medical services.Methods The priority setting method is applied in this study,and the incidence,prevalence,hospitalization rates and the ratio of different types of inpatient are used as indicators to reflect medical demand and utilization.The integrated balance method is also used,and the priority diseases list is made based on the analysis from the view of disease onset,considering the service delivery,social equity and the health financing.Results Based on the data analysis made,this paper proposed that the priority diseases cover 29,66 and 103 types for primary hospitals,secondary hospitals and tertiary hospitals respectively.The main diseases so determined include hypertension,diabetes, maternal and child health,severe mental illness,infectious diseases,emergency treatment,etc.Conclusions The method and result of setting priority disease and main disease can be the basis of setting for main diseases in essential medical services.