Analysis On Necessity And Feasibility Of Establishing Tumor And Cardiovascular Specialized Departments In County-level Public Hospitals In Guizhou Province

Objective:Analyze the necessity and feasibility of setting up the specialized department of cancer and cardiovascular disease in county-level public hospitals in Guizhou Province,and provide the basis for the discipline construction of county-level public hospitals in Guizhou Province.Methods:Data sources:?1?Based on 88 counties in Guizhou Province,taking economic factors into consideration,a stratified cluster sampling method was adopted to collect 7 counties such as Shuicheng County as a sample county.The office provided a detailed list of the county's new rural cooperative remittances from 2013 to 2015,including basic patient information,disease names,ICD-10 codes,inpatient institutions,hospital fees,and reimbursement expenses.?2?The self-made"County-level Hospital Survey Form"was issued to all public hospitals in the sample counties?generally including the people's hospital in the county and the Chinese medicine hospital in the county?.The questionnaire includes personnel,beds,equipment,and departments.2.Data analysis:?1?The collected NCMS reimbursement tables for each sample county public hospital from 2013 to 2015 were summarized and drawn into a list of diagnosis and treatment capabilities,which were returned to public hospitals in all sample counties.Organizational experts of each hospital filled in according to the actual diagnosis and treatment capabilities of the hospital.Getting the inpatient disease can be diagnosed and can not be treated in public hospitals in countis.?2?According to the medical institution where the patient visited,the inpatient disease was divided into two parts:within the county and outside the county.?3?Merging in-hospital diseases outside the county with the collected medical treatment ability tables to get the capacity and incapacity of the out-of-county diseases in the county.3.Statistical methods:Using statistical software SPSS 20.0 summarized,organized and analysised the relevant data.The measurement data obeying the normal distribution was described as mean±standard deviation?`X±S?;the statistical data was not subject to the normal distribution using the median and interquartile range M?P25,P75?,A Mann-Whitney U test was used to compare differences.Counting data was described by rate and composition ratio,the difference was compared usingc2 test.Checked the standard to takea=0.05.Results:?1?In the sample counties from 2013 to 2015,the visiting rate in the counties was not reach 90%,and the number of patients admitted to hospitals outside the county was increasing year by year,with an average growth rate of 4.81%.?2?In the past three years,the number of patients who had the ability to treat in the counties but had flowed out of the county,and the number ofpatients who did not have the ability to treat in the counties showed an upward trend.The average growth rates were 1.97%and 9.80%respectively.?3?From 2013 to 2015 year,there were significant differences in the total hospitalization expenses,compensation fees and out-of-pocket expenses of medical institutions in and out of the county?Z=-243.94,-217.18,-262.97,P<0.05?.?4?In the ranking of common system diseases in the sample counties,circulatory system diseases and tumors accounted for the sixth and eleventh respectively.?5?Compared with the ranking of common system diseases,the ranking of the total cost of common system diseases was quite different,and the largest change in the cost ranking was the tumor,rising from 11^thh to 5^thh to 6^th;circulatory system diseases rising from 6^thh to 3^rdd to 4^th.?6?During the three years,among the top ten diseases with the outpatient transfer rate,malignancy,cerebrovascular disease,and lens disease could not be diagnosed in the county,and the outpatient transfer rate of patients with these three diseases increased year by year.?7?In the past three years,the number of cancer patients outside the county was about 1.5-2.0 times the number of patients in the county.The average hospitalization expenses,reimbursement costs,and the average out-of-pocket costs of patients within and outside the county were statistically significant.?Z=-65.42,-58.56,-59.81,P<0.05?.?8?During the three years,the average hospitalization costs,reimbursement costs,and the average out-of-pocket costs for patients within and outside the county were statistically significant?Z=-88.84,-72.98,-104.83,P<0.05?.?9?Sample county hospitals can independently treat hypertension,common arrhythmia,stomach,colon and rectal malignancy;they could treat coronary heart disease and kidney,prostate,esophageal,and endometrial malignancy under the guidance of superior doctors.?10?In some public hospitals in the sample counties,the ratio of"care beds","medical beds","the ratio of health professionals to actual open beds",the number of clinical departments and medical equipment had not yet reached the national standards.Conclusion:?1?It is necessary for public hospitals at the county level in Guizhou Province to establish special departments for oncology and cardiovascular disease;?2?It is feasible to advance the specialization of cancer and cardiovascular diseases in public hospitals at the county level where the human resources are relatively adequate,facilities and equipment are relatively complete,and have certain diagnostic capabilities.