Objective To explore and construct the clinical questions and outcome indicators of the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome;To provide a basis for the subsequent preparation of this guide to form recommendations.Methods First,by searching the databases of seven major Chinese and English journals,including CNKI,the preliminary list of clinical problems and outcome indicators in the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome were sorted out,and then the clinical questions and outcome indicators that formed the recommendations of the guide were finally determined based on the modified Delphi method in the form of three rounds of online.The first two rounds were conducted in the form of online questionnaires filled out by experts,and the importance ratings of clinical issues and outcome indicators were imported into the SPSS 27.0 software for statistical analysis.The first and second rounds of clinical questions and outcome indicators were rated as the average score≥4,full score frequency≥30%,and the coefficient of variation≤25%,respectively;the inclusion criteria for entering the second round of evaluation were an average score of≥7 and an average score of≤25%.The third round would be further discussed and voted on by experts in an online consensus meeting,with a voting rate of≥80%as the standard to determine the final items to be included in the guidelines.Results A total of 109 questionnaires were distributed nationwide in the first round of inquiry,and 107 were collected;a total of 20 questionnaires were distributed for the second round of expert research,and 20 were collected.The positive coefficients of the first and second rounds of experts were 98.17%and 100%;the Cronbach coefficients of clinical questions were 0.937 and 0.943,respectively;the Cronbach coefficients of the outcome indicators were 0.970 and 0.940,respectively.In the third round,a total of 22 experts participated in the meeting and all voted,resulting in a positive coefficient of 100%and an authority coefficient of 0.88.13 clinical questions and 17 outcome indicators were finally included in Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome.Conclusion According to the results of the above three rounds of modified Delphi method,it indicates that the questionnaire survey in the process of formulating the guidelines is highly reliable,which can provide a reliable basis for the writing of this guide,and to provide a reference for the development of acupuncture guidelines in related fields.

Objective:To examine the differences in the medical quality of elderly Medicare patients in tertiary public hospitals before and after the implementation of the Diagnosis-related Group Prospective Payment System(DRG-PPS), and to explore the establishment of a long-term quality control mechanism.Methods:A total of 62, 321 inpatient first-page records was collected from Beijing Hospital, including 27, 488 cases from January to December 2019 and 34, 833 cases from January to December 2023.Firstly, the two-sample Kolmogorov-Smirnov test was applied to six sample DRG groups to analyze the statistical differences in the intra-group indicators(average per-case cost, average length of stay)among three age groups(young and middle-aged group: 18-65 years old; early elderly group: 66-79 years old; advanced elderly group: 80-99 years old)before and after the DRG-PPS reform of the medical insurance payment system.Secondly, the two-sample Kruskal-Wallis test was used to analyze the statistical differences in the indicators(total cost, medical cost, nursing cost, medical technology cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay)among the three age groups within the same DRG group.Finally, the Conover test was employed for pairwise comparisons of inter-group indicators between the three groups.Results:Through the intra-group analysis of the total cost and average length of stay indicators of different age groups in the six sample DRG groups( n=6, 248), it was found that the differences were statistically significant.( Z-values for total cost in groups 1-3 was 12.69, 15.73, and 11.45, respectively; Z-values for average length of stay were 8.33, 6.73, and 3.69, respectively; all P<0.05), indicating that the DRG-PPS reform was effective in controlling hospitalization costs and length of stay.The inter-group analysis revealed statistically significant differences in total cost, nursing cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay( H-values were 22.49, 41.86, 15.61, 200.56, 14.73 and 10.73, respectively; all P<0.05; ), suggesting that there were statistically significant differences in cost control among different age groups in the same DRG group.Furthermore, analysis of specific cases revealed that differences in medical costs among different age groups resulted from the combined effects of clinical practice standardization(reflected in the significant reduction of unnecessary examinations and medication)and policy interventions such as volume-based procurement excluding the adverse effects of cost containment on the medical quality of elderly patients in the six sample patient groups.No substantial rise was observed in the 31-day readmission rate, indicating that admission splitting was unlikely to have occurred. Conclusions:The implementation of the DRG-PPS contributed to cost efficiency in the sample hospital.By establishing a long-term quality control mechanism focused on DRG groups with significant cost reductions in elderly patients, abnormal cost-control behaviors can be effectively identified, and high-quality development of the hospital can be achieved while ensuring healthcare quality for elderly patients.

Objective To explore and construct the clinical questions and outcome indicators of the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome;To provide a basis for the subsequent preparation of this guide to form recommendations.Methods First,by searching the databases of seven major Chinese and English journals,including CNKI,the preliminary list of clinical problems and outcome indicators in the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome were sorted out,and then the clinical questions and outcome indicators that formed the recommendations of the guide were finally determined based on the modified Delphi method in the form of three rounds of online.The first two rounds were conducted in the form of online questionnaires filled out by experts,and the importance ratings of clinical issues and outcome indicators were imported into the SPSS 27.0 software for statistical analysis.The first and second rounds of clinical questions and outcome indicators were rated as the average score≥4,full score frequency≥30%,and the coefficient of variation≤25%,respectively;the inclusion criteria for entering the second round of evaluation were an average score of≥7 and an average score of≤25%.The third round would be further discussed and voted on by experts in an online consensus meeting,with a voting rate of≥80%as the standard to determine the final items to be included in the guidelines.Results A total of 109 questionnaires were distributed nationwide in the first round of inquiry,and 107 were collected;a total of 20 questionnaires were distributed for the second round of expert research,and 20 were collected.The positive coefficients of the first and second rounds of experts were 98.17%and 100%;the Cronbach coefficients of clinical questions were 0.937 and 0.943,respectively;the Cronbach coefficients of the outcome indicators were 0.970 and 0.940,respectively.In the third round,a total of 22 experts participated in the meeting and all voted,resulting in a positive coefficient of 100%and an authority coefficient of 0.88.13 clinical questions and 17 outcome indicators were finally included in Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome.Conclusion According to the results of the above three rounds of modified Delphi method,it indicates that the questionnaire survey in the process of formulating the guidelines is highly reliable,which can provide a reliable basis for the writing of this guide,and to provide a reference for the development of acupuncture guidelines in related fields.

Objective:To examine the differences in the medical quality of elderly Medicare patients in tertiary public hospitals before and after the implementation of the Diagnosis-related Group Prospective Payment System(DRG-PPS), and to explore the establishment of a long-term quality control mechanism.Methods:A total of 62, 321 inpatient first-page records was collected from Beijing Hospital, including 27, 488 cases from January to December 2019 and 34, 833 cases from January to December 2023.Firstly, the two-sample Kolmogorov-Smirnov test was applied to six sample DRG groups to analyze the statistical differences in the intra-group indicators(average per-case cost, average length of stay)among three age groups(young and middle-aged group: 18-65 years old; early elderly group: 66-79 years old; advanced elderly group: 80-99 years old)before and after the DRG-PPS reform of the medical insurance payment system.Secondly, the two-sample Kruskal-Wallis test was used to analyze the statistical differences in the indicators(total cost, medical cost, nursing cost, medical technology cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay)among the three age groups within the same DRG group.Finally, the Conover test was employed for pairwise comparisons of inter-group indicators between the three groups.Results:Through the intra-group analysis of the total cost and average length of stay indicators of different age groups in the six sample DRG groups( n=6, 248), it was found that the differences were statistically significant.( Z-values for total cost in groups 1-3 was 12.69, 15.73, and 11.45, respectively; Z-values for average length of stay were 8.33, 6.73, and 3.69, respectively; all P<0.05), indicating that the DRG-PPS reform was effective in controlling hospitalization costs and length of stay.The inter-group analysis revealed statistically significant differences in total cost, nursing cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay( H-values were 22.49, 41.86, 15.61, 200.56, 14.73 and 10.73, respectively; all P<0.05; ), suggesting that there were statistically significant differences in cost control among different age groups in the same DRG group.Furthermore, analysis of specific cases revealed that differences in medical costs among different age groups resulted from the combined effects of clinical practice standardization(reflected in the significant reduction of unnecessary examinations and medication)and policy interventions such as volume-based procurement excluding the adverse effects of cost containment on the medical quality of elderly patients in the six sample patient groups.No substantial rise was observed in the 31-day readmission rate, indicating that admission splitting was unlikely to have occurred. Conclusions:The implementation of the DRG-PPS contributed to cost efficiency in the sample hospital.By establishing a long-term quality control mechanism focused on DRG groups with significant cost reductions in elderly patients, abnormal cost-control behaviors can be effectively identified, and high-quality development of the hospital can be achieved while ensuring healthcare quality for elderly patients.

Objective:To explore the cost adjustment model based on age coefficient and to make the payment standard more consistent with the actual resource consumption in clinical settings partially address the issue of targeting elderly patients that may arise after the implementation of DRG-PPS payment.Methods:The study analyzed data from all discharged patients in a hospital in 2022.Case rate coefficients were calculated for different age groups(young-middle-aged group, early elderly group, and high-aged elderly group)using the DRG(Diagnosis-related Group)rate formula to adjust the payment standard.The statistical significance of the difference between the actual cost and the current payment standard(within-group difference)was determined using the paired t-test in SPSS software.The Wilcoxon rank sum test was then used to determine the statistical significance of the difference between the actual cost and the adjusted payment standard(between-group difference).To assess the applicability of the age coefficient adjustment model, 11 disease groups were selected, and the Wilcoxon rank sum test was used to determine if there was a statistical difference between the adjusted and non-adjusted groups.The effectiveness of the adjustment was judged based on the standard deviation. Results:There was no significant difference between the actual hospitalization costs and the current standards(Group 1)and the actual hospitalization costs and the adjusted payment standards(Group 2)( P values were 0.928 and 0.949, both greater than or equal to 0.05).The results of the rank sum test showed a statistical difference between the two groups( P value of less than 0.05).Group 1 had a median of -1 644.57, a mean of -999.04, a mean standard error of 70.35, and a standard deviation of 15 024.62.Group 2 had a median of -1 641.88, a mean of -998.50, a mean standard error of 70.32, and a standard deviation of 15 019.24. Conclusions:Both the current and adjusted rates accurately reflect the true cost of hospitalization for patients.However, the adjusted standard is more closely aligned with the actual costs and the model remains valid.partially address the issue of targeting elderly patients that may arise after the implementation of DRG-PPS payment.

Objective To form the in vitro diagnostic reagents(IVD)selection and optimization management plan and management database,and optimize the IVD management work.Methods Through the analysis of the policy background and the current management status of the IVD clinical laboratory in Beijing Hospital,the selection and optimization management plan for existing and newly applied laboratory IVD was formulated based on clinical needs.The IVD of the whole hospital was selected and optimized by combing projects,open bidding,innovative quotation methods,on-site review and other steps.The IVD management database and qualification database of Beijing Hospital was formed,and the effect from the aspects of compliance,work efficiency and cost control was evaluated.Results The selection and optimization of 1 737 IVDs in the whole hospital were completed according to the formulated IVD selection and optimization management plan.The implementation of management plan improved the work efficiency.The content of review in an average meeting was increased by more than 10 times,and the frequency of new applications for IVD access was accelerated,while the IVD cost was reduced,and the average purchase amount of the whole hospital was reduced by about 15％.The prices of key IVD products were lower after selection than before selection,and the difference was significant(t=2.493,P=0.034).Conclusion The management scheme of IVD selection and optimization was feasible,and it could achieve the goal of ensuring compliance,improving efficiency and reducing costs.

Objective To establish in vitro diagnostic(IVD)reagents closed-loop management scheme for the whole process and implement,and optimize the IVD management.Methods Based on the status quo of IVD management in Beijing Hospital,the closed-loop management scheme of the whole IVD process was designed,such as IVD application,IVD selection,IVD subscription,IVD purchase,IVD receipt,IVD inbound and outbound,and IVD use.Key indicators were selected to establish an evaluation framework.Management data,procurement data and testing data before(2020)and after(2023)implementation of the program were collected and counted by means of interviews and consulting relevant information systems,and then process management,quality management and cost management were evaluated.Results The management process was optimized,the IVD purchase time was shortened by about 60％on average,the IVD purchase did not need manual processing,the order was split in real time and sent to the corresponding supplier,and the IVD collection time was shortened by about 75％on average.IVD and test quality management were satisfactory,supplier qualification perfection reached 100％,full marks were obtained in the inter-room quality assessment,and no IVD-related adverse events were observed.The cost management was effective,and the IVD procurement cost was reduced by about 15％.IVD cost fine management models were established for four items,namely,human immunodeficiency virus antibody assay,hepatitis C antibody assay,treponemal antibody assay and hepatitis B surface antigen quantitative assay.The average value of IVD loss was 0.07％～1.21％,and the standard deviation was 0.07％～0.66％.Conclusion The IVD whole process closed-loop management scheme is feasible,which can improve the efficiency of IVD management,ensure the quality of IVD and detection,reduce the cost of IVD,and refine the cost management work.

Objective:To analyze the adjustment of the amount of medical insurance reimbursement with the addition of the age factor, making the system more in line with the actual clinical resource consumption.Methods:Data were collected from the first page of medical records of 54 535 inpatients discharged from hospital between January 1 th, 2021 and December 31 th, 2021.First, the paired t-test was used to verify any statistical difference between the standard payment amounts before and after adjustment based on the model and the actual hospitalization expenses.Secondly, the actual cost was compared with the cost after the model-based adjustment and the current benchmark cost(before adjustment), respectively.The standard deviations of the two groups were compared to assess the difference between the benchmark cost and the actual cost before and after adjustment. Results:Through the Blom formula, the actual cost, adjusted benchmark cost and current benchmark cost data were normalized.After normalization, the actual expenses and the adjusted benchmark cost as well as the actual expenses and the current benchmark cost were compared, respectively, using the paired t-test, producing a P value of 0.97 for the former pair and a P value of 0.93 for the latter pair, both greater than 0.05, and the benchmark cost before and after adjustment could reflect the actual clinical resource consumption.However, the effect of benchmark cost adjustment was assessed by analyzing the standard deviation of the difference between paired values of the two groups.The standard deviation of paired values between the actual expense and the adjusted benchmark cost was 0.68, lower than the standard deviation of paired values between the actual expense and current benchmark cost, which was 0.7. Conclusions:With the inclusion of the age factor, the model can reasonably adjust the current benchmark cost based on the patient's age and verify that the adjusted benchmark cost can more accurately reflect the actual clinical resource consumption compared with the current standard.However, further improvement of the payment adjustment model is still needed.

Objective:To build a comprehensive medical, teaching, and research discipline indicators system that is objective and easily accessible in data, and to develop a comprehensive evaluation method, at the same time provide references for discipline evaluation and orientation.Methods:Literature review was used in referring to the evaluation indicators of different ranking systems in China, Delphi method and Analytic Hierarchy Process(AHP) were applied to identify the indicators and their weight.Results:A comprehensive discipline evaluation indicator system, including 3 first-level indicators, 12 second-level indicators, and 41 third-level indicators, were constructed. The Cartesian coordinates allows for specifying the location of the medical, teaching, research level of certain discipline, and the distribution of relevant discipline groups in three-dimensional space.Conclusions:The indicators system for discipline evaluation in this study has the characteristics of refinedness, comprehensiveness, operability, and applicability, providing references for the future evaluation of disciplines.

Objective Through combing and analyzing the existing hospital rankings in China,comparing the similarities,differences and problems of existing rankings,to improve the hospital's understanding of the ranking work,and provide reference for hospital discipline construction and development.Methods To comprehensively review and compare the major ranking of hospitals in China,such as "China's Hospital Rankings","China's Hospitals · Competitiveness Rankings","Ranking of the Best Clinical Subjects in China","China Hospitals' Science and Technology Evaluation Metrics" and "Beijing Medical Service and Key Specialist Evaluation",and to analyze from the angle of the background,characteristics,evaluation methods,evaluation dimension and so on.Results At present,the hospital rankings have their own characteristics,each with its own focus,but there is still poor accessibility of clinical data,and the evaluation index of patients' medical experience and educational work are not perfect.Conclusions The hospital ranking list is a third-party evaluation tool to promote the construction of hospital disciplines effectively.It is recommended that all relevant organizations or departments further improve the construction of the ranking system,build big data platforms for hospital evaluation,improve the data accessibility of clinical medical quality and safety indicators,build scientific and objective dynamic evaluation systems,and carry out multi-level,multi-dimensional and continuous hospital ranking work.