1.Analysis of Inpatient Mortality Cases in a Tertiary General Hospital in Beijing Based on Diagnosis-related Groups
Yufei ZHANG ; Jiong ZHOU ; Xiaojun MA ; Xiaoran WANG
Medical Journal of Peking Union Medical College Hospital 2025;16(3):697-702
To analyze inpatient mortality cases in a tertiary general hospital in Beijing based on diagnosis-related groups (DRG), with the aim of providing references for healthcare quality management. We retrospectively collected DRG data of hospitalized patients admitted to a tertiary general hospital in Beijing from January 1, 2015, to December 31, 2023. Mortality cases were analyzed according to mortality risk stratification, with a focus on the temporal trends, departmental distribution, and DRG composition of low/medium-low mortality risk cases. Among 927 304 DRG-classified hospitalizations, 2346 cases resulted in death (stratified into 130 low-risk, 209 medium-low-risk, 411 medium-high-risk, and 1596 high-risk cases), yielding an overall mortality rate of 0.25%. The mortality rates were 0.02% (130/680 939) in the low-risk group and 0.16% (209/130 449) in the medium-low-risk group. From 2015 to 2023, the mortality rate showed a significant downward trend ( Critical care units accounted for the highest proportion of mortality cases, with surgical patients having complications/comorbidities representing the major DRG-related factors for low/medium-low-risk deaths. Hospitals should prioritize these findings by identifying areas for improvement, implementing multidisciplinary case reviews, and strengthening patient safety measures.
2.Study and Practice on Intelligent Classification of Medical Safety Incidents Based on BERT Model
Congpu ZHAO ; Da YUAN ; Pujue ZHU ; Jiong ZHOU ; Zheng CHEN ; Hua PENG
Journal of Medical Informatics 2024;45(1):27-32,38
Purpose/Significance To improve the classification and evaluation mode of medical safety incidents,and to improve work efficiency and timeliness.Method/Process The data of previous medical safety incidents are pre-processed,BERT model is used for training,testing and iterative optimization,and an intelligent classification and prediction model for medical safety incidents is built.Re-sult/Conclusion The model is used to classify 466 medical safety incidents reported by clinical departments from January to November 2022,and F1 value reaches 0.66.The application of BERT model in the classification and evaluation of medical safety incidents can im-prove work efficiency and timeliness,and help timely intervene in medical safety risks.
3.Focusing on the Benefits of Patient, Promoting the Sustainable Development of Medical Consortium
Wenting ZHENG ; Yuyu ZHOU ; Qiming JIN ; Yi YUAN ; Yanbin LIU ; Xiaojun MA ; Jiong ZHOU
Medical Journal of Peking Union Medical College Hospital 2024;15(5):1006-1010
As a practical carrier for promoting the tiered diagnosis and treatment model, the medical consor-tium is of great significance for balancing medical resources and boosting medical service efficiency. The construction of medical consortiums not only improves the accessibility of high-quality medical resources for patients, but also enhances the diagnostic and treatment level of member units. Meanwhile, it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction. As the core of medical insurance payment reform, DRG, through indicators such as the case mix index(CMI) and the number of diagnosis related group (DRG), provides objective and quantified data support for case management and disease structure optimization, thus effectively guiding the rational allocation of medical resources and the adjustmentof diseases and surgical types within the medical consortium. Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system, provides a clear direction for medical consortium cooperation, thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win-win situation for all parties involved. This paper, based on the "1+5+1" medical consortium cooperation model centered around Peking Union Medical College Hospital, utilizes DRG indicators to analyze the benefits for patients, member hospitals, and the leading hospital during the medical consortium construction process, with the hope of providing reference for the construction of a medical consortium evaluation system.
4.An Empirical Study on the Use of Diagnosis Related Group Tools for Grouping Adjustments in Large Public Hospitals
Guojie ZHANG ; Xutong TAN ; Zhiling CAI ; Qiang XU ; Weifeng XU ; Yihang CHEN ; Yating WANG ; Jinhan LIU ; Zheng CHEN ; Jiong ZHOU ; Xiaojun MA
Medical Journal of Peking Union Medical College Hospital 2024;15(5):1052-1058
To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources. We retrospectively collected DRG data from two surgical departments in a large public hospital in Beijing from 2017 to 2023. When the case mix index (CMI) of the two surgical departments declined, interventions such as performance appraisal, department education, and hospital publicity were promptly adopted. The changesin CMI values were observed and the trends in disease group weights, time consumption index, cost consumption index, and mortality rate in low-risk groups were analyzed. After the interventions, in surgical department Ⅰ, the proportion of patients with lower-weight diseases, such as major thyroid surgery (KD1), significantly decreased, while that of patients with higher-weight diseases, such as colorectal malignancy surgery (GB2) and pancreatic malignancy surgery (HB1), significantly increased. In surgical department Ⅱ, the proportion of patients with lower-weight diseases, such as chemotherapy (RE1), decreased markedly, while that of patients with higher-weight diseases, including major surgery for malignancy of kidney, ureter, and bladder (LA1), adrenal gland surgery (KC1), surgery for kidney/ureter/bladder except for major malignancy surgery (LB1), and male genital organ malignancy surgery (MA1), increased significantly. Both surgical departments achieved the goal of increasing their CMI values. In terms of efficiency, cost, and quality indicators, the time consumption index and cost consumption index of the two surgical departments were significantly lower than 1, and the mortality rate in low-risk groups was 0. Based on actual conditions and development goals, large public hospitals can achieve improvements in CMI values and optimization of disease group structures through reasonable interventions, thereby enhancing medical efficiency and rational utilization of resources.
5.Improving Medical Quality and Safety Through DRG Payment Model
Jiong ZHOU ; Shuchang WANG ; Xiaojun MA
Medical Journal of Peking Union Medical College Hospital 2024;15(5):981-986
Amid challenges of adapting to an aging society and maintaining sustainable healthcare financing, DRG forms a comprehensive suite of healthcare management tools, serving not only as a payment management tool but also encompassing budget management and healthcare quality control. However, further exploration of DRG's potential, which includes stimulating intrinsic motivations, and maximizing its positive incentive effects, requires continuous exploration and implementation. This paper discusses the standardization of clinical practices, localization of guidelines, minimization of iatrogenic harm, and popularization of economic evaluation, with the aiming of optimizing clinical pathways, standardizing medical practices, and balancing the challenges and opportunities of cost control and clinical innovation under the DRG payment model.
6.High-quality Disease Classification in Line with International Standards: Current Status and Reflections
Medical Journal of Peking Union Medical College Hospital 2024;15(5):993-998
With the widespread adoption of the International Classification of Diseases (ICD) in China's medical evaluation and healthcare payment systems, the importance of disease classification coding has become increasingly prominent, drawing considerable attention from the industry. As ICD is rapidly promoted and applied, various work methods have been developed, with it disagreements in understanding have emerged. Some medical institutions strictly require physicians to select clinical diagnoses from the ICD list of disease and surgical names. This practice undermines and even replaces the coding process conducted by the professional coders, leading to practical issues and affecting the data quality. This article analyzes these issues and proposes that the diagnoses entered by physicians on the first page of medical records are essentially disease nomenclature, while ICD codes represent classified diagnoses. These two elements have fundamentally different purposes andfunctions. It is recommended that physicians understand the requirements of ICD coding for clinical diagnosis documentation, revert to a medical-centric mindset, and accurately record disease diagnoses by using disease nomenclature. For the ICD-coded data, the key to high quality lies in strictly adhering to ICD classification rules and aligning with international standards. Professional medical record coders should be trained in health informatics, master international classification rules to fulfill their responsibilities, and ensure the accurate transformation of clinical diagnoses into ICD codes.
7.With CHS-DRG Grouping Payment Scheme Significantly Upgraded, How Should Medical Institutions Respond?
Guojie ZHANG ; Jiong ZHOU ; Xutong TAN ; Xiaojun MA ; Zhi WANG ; Qing CHANG
Medical Journal of Peking Union Medical College Hospital 2024;15(5):999-1005
In July 2024, the National Healthcare Security Administration issued "Notice on Printing and Distributing the 2.0 Edition Grouping Scheme for Diagnosis Related Group(DRG) and Disease-based Payment and Further Advancing Related Work, " marking the official entry of China's DRG payment reform into the 2.0 era. In the 2.0 edition of the DRG grouping scheme, the number of DRGs has increased by six groups, and that of the adjacent DRGs has increased by 33 groups, featuring more scientific and reasonable grouping that aligns better with clinical practice. The National Healthcare Security Administration has also clarified five supporting management mechanisms, including the special case negotiation mechanism, the fund prepayment mechanism, the negotiation and consultation mechanism, the feedback mechanism for opinion collection, and the data disclosure mechanism. These are aimed at optimizing the management of DRG payment reform to ensure a win-win situation for medical institutions, healthcare security departments, and patients. The release of the DRG 2.0 edition provides medical institutions with more refined management tools and a more reasonable paymentmechanism. Medical institutions need to actively embrace this reform, optimize internal management, and improve service quality to achieve cost control and efficiency enhancement, ultimately leading to a win-win situation for patients, healthcare security funds, and medical institutions.
8.Epidural Labor Analgesia: Comfort and Safety Run in Parallel, with Teaching and Quality Control Complementing Each Other
Yu ZHANG ; Mengyun ZHAO ; Lijian PEI ; Yahong GONG ; Xia RUAN ; Yuguan ZHANG ; Di XIA ; Zhilong LU ; Zhanjie ZHANG ; Jiong ZHOU ; Chenwei FU ; Jinsong GAO ; Yuguang HUANG
Medical Journal of Peking Union Medical College Hospital 2024;15(2):246-250
Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.
9.The Construction Status and Development Trend of Smart Hospital in China
Da YUAN ; Congpu ZHAO ; Pujue ZHU ; Jieshi ZHANG ; Zheng CHEN ; Jiong ZHOU ; Xiaojun MA ; Hua PENG
Journal of Medical Informatics 2024;45(7):33-36
Purpose/Significance To expound the development status,difficulties and challenges of smart hospital in China,so as to pro-vide references for the subsequent related research.Method/Process By using the methods of bibliometrics and literature review,the definition of smart hospital is summarized and feasible suggestions on the construction of smart hospital are put forward.Result/Conclusion Smart hospital in China has initially established a"trinity"structural framework of smart healthcare,smart service and smart management,playing a positive role in improving patient satisfaction and promoting high-quality development of hospitals.It is necessary for the government,hospitals,social capital and other multi-party cooperation to jointly promote the construction of smart hospital in China and better protect people's health.
10.Research progress of breast reconstruction in the prevention and treatment of breast cancer-related lymphedema
Yue ZHOU ; Shuang HAO ; Jiong WU
Chinese Journal of Surgery 2024;62(8):787-792
Advances in the diagnosis and treatment of breast cancer have significantly improved survival rates. Breast cancer-related lymphedema is the most common mid-and long-term complication after breast cancer surgery, which seriously affects the quality of life. Breast reconstruction can not only restore the shape of the breasts after mastectomy, but also reduce the occurrence of lymphedema to some extent. Immediate autologous breast reconstruction combined with lymphatic venous anastomosis (LVA) or vascularized lymph node transfer (VLNT) can effectively prevent lymphedema. Delayed breast reconstruction combined with LVA or VLNT can achieve the dual benefits of restoring the appearance and treating lymphedema at the same time. The autologous tissue flap can function as a bridge to promote lymphatic drainage, thus enhancing the treatment of lymphedema. The advances mentioned above in surgical techniques have provided a basis for decision making in breast reconstruction and the prevention and treatment of breast cancer-related lymphedema, and have also brought hope for improving the quality of life of patients.

Result Analysis
Print
Save
E-mail