Trying to provide ultrasonic image-aid measures for quantitative diagnosis and dynamic monitoring of liver fibrosis, we propose two scoring methods for liver fibrosis tissue in vivo, based on ultrasound radio frequency (RF) time series in this paper. Firstly, RF echo signals of human liver were recorded in this study. Then one of the recorded frame RF data was demodulated to be B model image. After that, a region of interest (ROI) in the B model image was selected. For each point in the ROI, its all frame data were acquired so that RF time series were formed. An SMR (size measure relationship) fractal dimension and six spectral features were extracted from RF time series in the ROI. With relative deviation and Fisher's discriminant ratio, seven features were weighted and summed so that the liver tissues' scores were obtained, Score-rd and Score-fisher, respectively. Area under ROC curve (AUC) and a support vector machine (SVM) were used to evaluate whether these scoring methods would be useful in distinguishing normal and cirrhosis tissues. Experimental results are shown as follows: Score-rd's AUC was 0.843, while Score-fisher was 0.816, SVM classification accuracies were both up to 87.5%. This proved that our proposed scoring methods were effective in distinguishing normal and cirrhosis tissues. Score-rd and Score-fisher have potential for clinical applications. They can also provide quantitative references for liver fibrosis diagnosis.
Interrupted time series (ITS) analysis is a quasi-experimental design for evaluating the effectiveness of health interventions. By controlling the time trend before the intervention, ITS is often used to estimate the level change and slope change after the intervention. However, the traditional ITS modeling strategy might indicate aggregation bias when the data was collected from different clusters. This study introduced two advanced ITS methods of handling hierarchical data to provide the methodology framework for population-level health intervention evaluation.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
The interrupted time series analysis was used to evaluate the incentive effect of the management methods of the SCI thesis fund for scientific research in West China Hospital of Sichuan University. We found an increase in number of the SCI papers and the growth rate after the adoption of scientific research incentive measures, indicating that the management methods of the SCI thesis fund had the incentive effect of scientific research. The interrupted time series analysis could be used in the incentive analysis of scientific research.
Objective To explore the impact of diagnosis-related group (DRG) payment method reform under total amount control on neurology and neurosurgery departments. Methods The DRG grouping data of the Department of Neurology and the Department of Neurosurgery of Panzhihua Central Hospital from January 2018 to December 2020 were collected, and the mature DRG evaluation indexes in China were selected. Using the interrupt time series analysis method, the DRG-related indexes of the two departments before and after the introduction of the performance appraisal plan in July 2019 were compared, to evaluate the intervention effects on the two departments. Results Both neurology and neurosurgery departments showed a slow downward trend in the overall medical service capacity under the DRG payment. The efficiency of medical services showed a slow upward trend and the consumption of medical expenses showed a slow downward trend in the Department of Neurology, while the efficiency of medical services showed a slow downward trend and the consumption of medical expenses showed a slow upward trend in the Department of Neurosurgery. According to the results of interrupt time series analysis, in the Department of Neurosurgery, the total weight showed a significant downward trend before intervention (β1=?5.526, P=0.003), and the downward trend became sluggish after intervention, with a statistically significant slope difference before and after intervention (β3=4.546, P=0.047); the case-mix index showed a downward trend before intervention (β1=?0.050, P<0.001), and no obvious trend after intervention, with a statistically significant slope difference before and after intervention (β3=0.052, P=0.001); the cost consumption index showed no obvious downward trend before intervention (β1=?0.006, P=0.258), and an upward trend after intervention, with a statistically significant slope difference before and after intervention (β3=0.027, P=0.032). The impact of this assessment plan on the Department of Neurology was not statistically significant (P>0.05), needing further observation. Conclusions The reform of DRG payment method under total amount control has different effects on the evaluation indicators of clinical departments of different natures. It is recommended to implement classified management and assessment for clinical departments of different natures.
Objective To explore the performance management intervention effect and optimization mode analysis of prefecture-level city hospitals under the reform of diagnosis-intervention packet (DIP) payment system. Methods Taking Deyang peopel’s hospital as the research object and 2021 as the time node of the DIP payment system reform, the data related to the hospital’s operational performance before the implementation of DIP payment (2019-2020) and the hospital’s operational performance after the implementation of DIP (2021-2022) were collected. The performance management evaluation system of Deyang peopel’s hospital was constructed based on game combination weights. The performance management level of Deyang People’s Hospital was measured, and the changes in hospital performance before and after the implementation of DIP payment system reform were analyzed through the construction of the interrupted time series model. Results After the implementation of DIP payment system reform in Deyang People’s Hospital, it had a significant impact on drug revenue, consumables revenue, and medical service revenue (P<0.05). Among them, drug revenue, examination revenue, acceptance revenue before the DIP payment system reform all showed a downward trend, medical service revenue showed an overall upward trend. However, there was no significant impact on the average hospitalization days of the patients, inpatient per capita medical costs, outpatient per capita medical costs, and the proportion of hospitalization income from the health insurance fund for patients (P>0.05). Conclusion The implementation of the DIP payment system can effectively improve the comprehensive level of performance of Deyang peopel’s hospital.
Photoplethysmography (PPG) is often affected by interference, which could lead to incorrect judgment of physiological information. Therefore, performing a quality assessment before extracting physiological information is crucial. This paper proposed a new PPG signal quality assessment by fusing multi-class features with multi-scale series information to address the problems of traditional machine learning methods with low accuracy and deep learning methods requiring a large number of samples for training. The multi-class features were extracted to reduce the dependence on the number of samples, and the multi-scale series information was extracted by a multi-scale convolutional neural network and bidirectional long short-term memory to improve the accuracy. The proposed method obtained the highest accuracy of 94.21%. It showed the best performance in all sensitivity, specificity, precision, and F1-score metrics, compared with 6 quality assessment methods on 14 700 samples from 7 experiments. This paper provides a new method for quality assessment in small samples of PPG signals and quality information mining, which is expected to be used for accurate extraction and monitoring of clinical and daily PPG physiological information.
The study of complex networks has become a hot research area of electroencephalogram signal. Electroencephalogram time series generated by the network keeps node information of network, so studying the time series from the network can also achieve the purpose of study epileptic electroencephalogram. In this paper, we propose a method to analyze epileptic electroencephalogram based on time series which is based on improved k-nearest neighbor network. The results of the experiment showed that studying power spectrum of time series from network was easier than power spectrum of time series directly generated from the original brain data to distinguish between normal controls and epileptic patients. In addition, studying the clustering coefficient of improved k-nearest neighbor network was able to distinguish between normal persons and patients with epilepsy. This study can provide important reference for the study of epilepsy and clinical diagnosis.
Objective To evaluate the impact of the trusteeship of Guang’an People’s Hospital by West China Hospital, Sichuan University on its operational efficiency and quality, so as to provide empirical evidence for the construction of trusteeship-style medical alliances. Methods Annual operational data of Guang’an People’s Hospital from 2013 to 2024 were collected. Taking the initiation of trusteeship in September 2015 as the intervention point (2013-2015 as the pre-trusteeship period and 2016-2024 as the post-trusteeship period), 15 evaluation indicators were selected across six dimensions: operational efficiency, economic performance, medical service quality, discipline development and research, workforce development, and patient satisfaction. Between-group comparisons were performed using the Welch t-test or Mann-Whitney U test. Interrupted time series analysis (ITSA) with segmented regression was conducted to assess level and trend changes of each indicator before and after the trusteeship, with the Newey-West method used to correct for autocorrelation and the Durbin-Watson statistic to test residual autocorrelation. Results Compared with the pre-trusteeship period, annual outpatient and emergency visits, annual discharges, total revenue, medical revenue, the proportion of level-Ⅲ and level-Ⅳ surgeries, total research funding, and the number of locally trained postgraduate staff increased significantly after trusteeship (P<0.05), while the drug revenue proportion and bed occupancy rate decreased significantly (P<0.05). ITSA results showed that after trusteeship, the growth trend of annual outpatient and emergency visits was significantly enhanced (β3=35941.23 visits/year, P<0.05); the average length of stay declined at an accelerated rate (β3=?0.17 days/year, P<0.05); the bed occupancy rate fell significantly (β3=?8.20 percentage points/year, P<0.05); the decline in drug revenue proportion further accelerated (β3=?1.05 percentage points/year, P<0.05), dropping from 41.8% to 19.6%; the growth trend of examination revenue proportion increased significantly (β3=0.61 percentage points/year, P<0.05); the proportion of level-Ⅲ and level-Ⅳ surgeries rose instantly by 6.89% (P<0.05); and the growth slope of locally trained postgraduate staff increased significantly (β3=7.97 persons/year, P<0.05). No statistically significant level or trend changes were observed for annual discharges, total revenue, or medical revenue (P>0.05); the number of research projects, total research funding, and publications showed no sustained improvement after trusteeship (all β3<0, P<0.05); and outpatient and inpatient satisfaction scores stayed high and stable at approximately 95 points. Conclusions The trusteeship-style medical alliance model of West China Hospital, Sichuan University has effectively and significantly strengthened the long-term growth trend of service volume in the trustee hospital, continuously improved its operational efficiency and revenue structure, markedly enhanced its capacity for the diagnosis and treatment of complex and severe diseases, and effectively promoted the development of local healthcare personnel. This model provides a replicable practical pathway for deepening the reform of the medical and health system and promoting the downward extension of high-quality medical resources.