Objective:To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure,with a focus on identifying the threshold effect,and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.Methods:Using a stratified random sampling method,individual reimbursement data of heart failure pa-tients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted.A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect.The annual outpatient service utilization indicators included the annual outpatient visits,annual outpatient expenses,annual outpatient drug expenses,and annual outpatient self-expenses within the policy.Hospitalization rate indicators comprised the annual hospitalization rate,rehospitalization rate within 30 days,and rehospitalization rate within 90 days.Results:(1)The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate.However,the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant;(2)The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified.When the prior-year annual outpatient visits were less than or equal to the threshold(12 visits),the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant,and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold(12 visits).Correspondingly,the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan,respectively.Conclusion:There is a threshold effect of prior-year annual outpatient service utilization on the current year's annual hospitalization rate in heart failure patients.These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitali-zation rates.Specifically,policymakers should consider the identified thresholds when designing reim-bursement policies for heart failure patients,which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Objective:To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure,with a focus on identifying the threshold effect,and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.Methods:Using a stratified random sampling method,individual reimbursement data of heart failure pa-tients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted.A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect.The annual outpatient service utilization indicators included the annual outpatient visits,annual outpatient expenses,annual outpatient drug expenses,and annual outpatient self-expenses within the policy.Hospitalization rate indicators comprised the annual hospitalization rate,rehospitalization rate within 30 days,and rehospitalization rate within 90 days.Results:(1)The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate.However,the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant;(2)The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified.When the prior-year annual outpatient visits were less than or equal to the threshold(12 visits),the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant,and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold(12 visits).Correspondingly,the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan,respectively.Conclusion:There is a threshold effect of prior-year annual outpatient service utilization on the current year's annual hospitalization rate in heart failure patients.These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitali-zation rates.Specifically,policymakers should consider the identified thresholds when designing reim-bursement policies for heart failure patients,which may help to optimize the use of medical resources and reduce the burden of medical expenses.

The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.

Objective To investigate the prevalence and correlates of depression in residents aged 15 and older in Hainan province.Methods Stratified multistage random sampling methods were utilized to identify 12 117 individuals (≥15 years old) from 59 villages (neighborhoods) in 24 towns (streets) within 6 counties (cities) in Hainan Province from September 2010 to November 2011.The subjects were screened with an expanded version of the General Health Questionnaire (GHQ-12) and the respondents were divided into three groups by high risk,moderate risk and low risk of mental disorder,followed by formal diagnosis according to the Structured Clinical Interview for DSM-IV-TR (SCID-I/P) by psychiatrists among 100％ subjects in group with high risk,40％ subjects in group with moderate risk and 10％ subjects in group with low risk.The adjusted rate,standardized rate,and 95％ confidence interval (95％CI) of the one-month and lifetime prevalence were also calculated among the 3 groups of individuals who were diagnosed with depressive disorder.The difference in whether they suffered depression was determined by the chi-squared test.Correlations to depressive disorder and the odds ratio (OR) were explored with multiple regression analysis.Results There were 97 cases of depressive disorders (1-month) and 166 cases of lifetime depressive disorders finally confirmed.The adjusted rate of 1-month prevalence was 1.38％ (95％CI:1.12-1.59) and the life-time adjusted prevalence rate was 2.80％ (95％CI:2.51-3.09).Female (OR=1.55,95％CI:1.12-2.14),mid-age(50-64 y,OR=1.84,95％CI:1.13-2.99),being divorced or living separated (OR=4.87,95％CI:1.86-12.73),suffering chronic diseases (OR=2.19,95％CI:1.56-3.07),and low family income were significantly associated with suffering depressive disorder.Conclusions The prevalence of the depressive disorder among residents aged 15 and older in Hainan province is lower than the nationwide prevalence.People who are female,mid-age,being divorced or not living with the partner,earning a low income,and suffering chronic diseases have more predisposition to develop the depressive disorder in Hainan province.

Objective To investigate the prevalence and correlates of depression in residents aged 15 and older in Hainan province.Methods Stratified multistage random sampling methods were utilized to identify 12 117 individuals (≥15 years old) from 59 villages (neighborhoods) in 24 towns (streets) within 6 counties (cities) in Hainan Province from September 2010 to November 2011.The subjects were screened with an expanded version of the General Health Questionnaire (GHQ-12) and the respondents were divided into three groups by high risk,moderate risk and low risk of mental disorder,followed by formal diagnosis according to the Structured Clinical Interview for DSM-IV-TR (SCID-I/P) by psychiatrists among 100％ subjects in group with high risk,40％ subjects in group with moderate risk and 10％ subjects in group with low risk.The adjusted rate,standardized rate,and 95％ confidence interval (95％CI) of the one-month and lifetime prevalence were also calculated among the 3 groups of individuals who were diagnosed with depressive disorder.The difference in whether they suffered depression was determined by the chi-squared test.Correlations to depressive disorder and the odds ratio (OR) were explored with multiple regression analysis.Results There were 97 cases of depressive disorders (1-month) and 166 cases of lifetime depressive disorders finally confirmed.The adjusted rate of 1-month prevalence was 1.38％ (95％CI:1.12-1.59) and the life-time adjusted prevalence rate was 2.80％ (95％CI:2.51-3.09).Female (OR=1.55,95％CI:1.12-2.14),mid-age(50-64 y,OR=1.84,95％CI:1.13-2.99),being divorced or living separated (OR=4.87,95％CI:1.86-12.73),suffering chronic diseases (OR=2.19,95％CI:1.56-3.07),and low family income were significantly associated with suffering depressive disorder.Conclusions The prevalence of the depressive disorder among residents aged 15 and older in Hainan province is lower than the nationwide prevalence.People who are female,mid-age,being divorced or not living with the partner,earning a low income,and suffering chronic diseases have more predisposition to develop the depressive disorder in Hainan province.

Objective:To introduce several international long-term care insurance systems so as to provide references for building China's long-term care insurance system.Methods:Literature of International long-term care insurance system were reviewed to extract and summarize the content so as to provide suggestion and references for China's system construction.Results:It concluded 4 modes of systems for long-term care insurance including the private long-term care social insurance like Netherlands,the public long-term care social insurance like German and Japan,long-term care commercial insurance like America and national long-term care insurance like England.The advantages of different modes could be learned to form Chinese system.Conclusion:The long-term care insurance systems of Netherlands,German,Japan,American could be learned for our system construction,but they also had disadvantages.Therefore,on the basis of the foster strengths and circumvent weaknesses,the reasonable long-term care insurance system was formed.