Objective To systematically evaluate the service efficiency and its differences among different types of medical institutions in Guangdong under the background of DRG payment reform,and to provide reference for optimizing regional medical insurance payment policies.Methods Using data from the Comprehensive Evaluation and Analysis Report on DRG Inpatient Medical Services in Guangdong Province in 2023,it compared the service efficiency differences among different types of medical institutions in Guangdong under the background of DRG payment reform,employing the length of stay consumption index,cost consumption index,and drug and consumable cost consumption index as research indicators.The Kruskal-Wallis H test was used to compare the service efficiency differences among different types of medical institutions in Guangdong,and linear regression analysis was applied to explore the relationship between the cost consumption index and the drug and consumable cost consumption index.Results There were statistically significant differences in the length of stay consumption index,cost consumption index,and drug and consumable cost consumption index among different types of medical institutions in Guangdong(P＜0.05).For the same disease group,the average length of hospital stay in Traditional Chinese Medicine hospitals is longer;the average hospitalization costs and drug expenditure per visit in tertiary public general hospitals are higher;while the average length of hospital stay and average hospitalization costs per visit in secondary public general hospitals,maternal and child health care hospitals,and county people's hospitals are relatively lower.Conclusion It needs to establish a quantitative management mechanism based on the DRG indicator system,improve dynamic adjustment and incentive policies for medical insurance payments,and optimize TCM-specific DRG grouping and payment standards,in order to systematically promote the reform of medical insurance payment methods.

Objective To systematically evaluate the service efficiency and its differences among different types of medical institutions in Guangdong under the background of DRG payment reform,and to provide reference for optimizing regional medical insurance payment policies.Methods Using data from the Comprehensive Evaluation and Analysis Report on DRG Inpatient Medical Services in Guangdong Province in 2023,it compared the service efficiency differences among different types of medical institutions in Guangdong under the background of DRG payment reform,employing the length of stay consumption index,cost consumption index,and drug and consumable cost consumption index as research indicators.The Kruskal-Wallis H test was used to compare the service efficiency differences among different types of medical institutions in Guangdong,and linear regression analysis was applied to explore the relationship between the cost consumption index and the drug and consumable cost consumption index.Results There were statistically significant differences in the length of stay consumption index,cost consumption index,and drug and consumable cost consumption index among different types of medical institutions in Guangdong(P＜0.05).For the same disease group,the average length of hospital stay in Traditional Chinese Medicine hospitals is longer;the average hospitalization costs and drug expenditure per visit in tertiary public general hospitals are higher;while the average length of hospital stay and average hospitalization costs per visit in secondary public general hospitals,maternal and child health care hospitals,and county people's hospitals are relatively lower.Conclusion It needs to establish a quantitative management mechanism based on the DRG indicator system,improve dynamic adjustment and incentive policies for medical insurance payments,and optimize TCM-specific DRG grouping and payment standards,in order to systematically promote the reform of medical insurance payment methods.

Objective: To explore the characteristics and short-term changes of high resolutionCT (HRCT) in subclinical stage of new coronavirus pneumonia (NCP). Methods: TheHRCT images of 17 NCP patients in subclinical stage were analyzed retrospectively in Union Hospital of Tongji Medical College, Huazhong University of science and technology and Wuhan JinyintanHospital from January 15 to January 31, 2020. There were 4 males and 13 females, aged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with NCP patients. The follow-up CT examination was performed 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation andsymptomatic therapy, while the orther 11 patients were untreated. The CT imaging signs of subclinical and short-term follow-up were analyzed, and the CT image changes of short-term follow-up was summarized. Results: Thelesions of 17 NCP patients were mainly located at the lower lobes of both lungs (9 cases at the left lower lobe and 10 cases at the right lower lobe in the subclinical stage, 9 casesat the left lower lobe and 11casesat the right lower lobe in the short-term follow-up). The number of lung segments involved increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, most of the lesions were multiple (13 cases), while in the short-term follow-up, the number of multiple cases decreased (7 cases), focal (6 cases) and diffuse distribution(4 cases) increased. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle (10 cases). In the short-term follow-up, 1 case progressed from subpleural to subpleural and along the bronchovascular bundle. There were 3 main types of lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, ground glass nodules were seen in all the 17 cases. In the short-termfollow-up, ground glass nodules decreased in 4 cases and crazy-paving pattern increased in 4 cases. In 6 patients after treatment, 3 cases were changed from multiple to single ground glass nodule, 3 cases showed multiple ground glass opacity reduced. Therange of lesions in 11 patients without treatment enlarged. Conclusion TheHRCT features of the NCP patients in subcilincal stagehave some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural or along the bronchovascular bundle, and the great changescan be seen in the short-term follow-up.

Objective:To explore the characteristics and short-term changes of high resolution CT (HRCT) in subclinical stage of COVID-19.Methods:The HRCT images of 17 COVID-19 patients in subclinical stage were analyzed retrospectively in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Wuhan Jinyintan Hospital from January 15 to 31, 2020. There were 4 males and 13 females, age ranged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with other COVID-19 patients. The follow-up CT examination was performed within 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation and symptomatic therapy, while the other 11 patients were untreated. The subclinical CT findings and short-term follow-up were analyzed, and the CT changes of short-term follow-up were summarized.Results:The lesions of 17 COVID-19 patients were mainly located at the lower lobes of bilateral lungs (at the left lower lobe in 9 cases and at the right lower lobe in 10 cases in the subclinical stage, at the left lower lobe in 9 cases and at the right lower lobe in 11 cases in the short-term follow-up). The number of involved lung segments increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, the multiple lesions were found in 13 cases, while in the short-term follow-up, the number of cases with multiple lesions decreased by 7, however the cases with focal lesions increased by 6 and diffuse lesions by 4. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle(10 cases). In the short-term follow-up, the lesion in 1 case expanded from the subpleural area to neighbouring bronchovascular bundle. There were 3 main types of the lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, the ground glass opacities were seen in all the 17 cases. In the short-term follow-up, the number of cases with ground glass nodules decreased by 4 and crazy-paving pattern increased by 4. In 6 patients after treatment, the multiple ground glass nodules became single one in 3 cases, and in other 3 cases the multiple ground glass opacities were getting smaller. However, the scope of lesions in 11 patients without treatment enlarged.Conclusion:The HRCT features of the COVID-19 in subcilincal stage have some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural area or along the bronchovascular bundle, and the great changes can be seen in the short-term follow-up.

Background: Most patients including health care workers (HCWs) survived the coronavirus disease 2019 (COVID-19), however, knowledge about the sequelae of COVID-19 after discharge remains limited. Methods: A prospectively observational 3-month follow-up study evaluated symptoms, dynamic changes of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG and IgM, lung function, and high resolution computed tomography (HRCT) of survivors of COVID-19 after discharge at Wuhan Union Hospital, China. Results: Seventy-six survivors (55 females) with a mean age of 41.3 ± 13.8 years were enrolled, and 65 (86%) were HCWs. A total of 69 (91%) patients had returned to their original work at 3-months after discharge. Most of the survivors had symptoms including fever, sputum production, fatigue, diarrhea, dyspnea, cough, chest tightness on exertion and palpitations in the three months after discharge. The serum troponin-I levels during the acute illness showed high correlation with the symptom of fatigue after hospital discharge (r = 0.782; P = 0.008) and lymphopenia was correlated with the symptoms of chest tightness and palpitations on exertion of patients after hospital discharge (r = −0.285, P = 0.027; r = −0.363, P = 0.004, respectively). The mean values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity and diffusion capacity were all normal (> 80% predicted) and lung HRCTs returned to normal in most of the patients (82%), however, 42% of survivors had mild pulmonary function abnormalities at 3-months after discharge. SARS-CoV-2 IgG turned negative in 11% (6 of 57 patients), 8% (4 of 52 patients) and 13% (7 of 55 patients), and SARS-CoV-2 IgM turned negative in 72% (41 of 57 patients), 85% (44 of 52 patients) and 87% (48 of 55 patients) at 1-month, 2-months and 3-months after discharge, respectively. Conclusion Infection by SARS-CoV-2 caused some mild impairments of survivors within the first three months of their discharge and the duration of SARS-CoV-2 antibody was limited, which indicates the necessity of long-term follow-up of survivors of COVID-19.