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Epidemiology and disease burden of complex wounds for inpatients in China: an observational study from Sichuan province.

ABSTRACT: OBJECTIVES:To investigate the period prevalence of complex wounds among the overall inpatients, and the impact of complex wounds on inpatient health expense and length of hospital stay (LOS). DESIGN:An observational study. SETTING:6056 healthcare institutions across Sichuan province in China. PARTICIPANTS:This study included 4?033?763 people admitted to healthcare institutions during 1 September 2018 and 31 December 2018. RESULTS:The point prevalence of complex wounds was 4.07 per 1000 among inpatients in Sichuan. The most common complex wounds were pressure ulcers (1.47 per 1000 among inpatients). Older, male, Han ethnic groups and retired people were most likely to suffer from complex wounds. The median LOS was longer for those with complex wounds as their main condition of treatment compared with all-cause admissions in Sichuan (12 days compared with 7 days; p<0.001). The median cost of care for people with complex wounds was higher than for admission for any cause (¥6500.18 compared with ¥3337.16; p<0.001). People with pressure ulcers had the longest LOS, while people with ulcers related to diabetes incurred the highest costs. CONCLUSIONS:Complex wounds, especially pressure ulcers, are common in Sichuan province and their presence is associated with significantly longer lengths of hospital stay and higher medical costs. Additionally, this study only included admitted inpatients during the sampling time period, hence the prevalence of complex wounds may be underestimated. The high prevalence rate and heavy direct and indirect disease burden of complex wounds indicate that health policies for early detection and prevention of complex wounds in elders are urgently needed.

SUBMITTER: Jiang Q

PROVIDER: S-EPMC7651747 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Epidemiology and disease burden of complex wounds for inpatients in China: an observational study from Sichuan province.

Jiang Qingling Q Dumville Jo C JC Cullum Nicky N Pan Jay J Liu Zhenmi Z

BMJ open 20201106 11

<h4>Objectives</h4>To investigate the period prevalence of complex wounds among the overall inpatients, and the impact of complex wounds on inpatient health expense and length of hospital stay (LOS).<h4>Design</h4>An observational study.<h4>Setting</h4>6056 healthcare institutions across Sichuan province in China.<h4>Participants</h4>This study included 4 033 763 people admitted to healthcare institutions during 1 September 2018 and 31 December 2018.<h4>Results</h4>The point prevalence of comple ...[more]

PMID: 33158828

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Project description:BackgroundThe overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China.MethodsPatient discharge records (n = 1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs.ResultsA small number of tertiary hospitals (n = 75, 12.41%) shared 51.71% (n = 770,823) of all admitted cases while a large number of primary/unrated hospitals (n = 321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR = 1.13) and those with a lower level of insurance entitlements (OR = 1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees).ConclusionThe level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.

Project description:BackgroundSince 1950, the hospitals had been permitted to take a 15% mark-up of drug purchase price to remedy the loss of public hospitals and doctors' salaries in China due to tight government budget. This policy resulted in an increasing over-prescriptions which increased burden for patients eventually. The soaring medical expenditures prompted Chinese government to launch the zero mark-up drug policy (ZMDP) in 2009, which aims to eliminate physicians' financial incentives and lighten patients' economic burden through cancelling the 15% mark-up. The purpose of this study is to assess the impacts of the ZMDP on hospitalization expenses for inpatients with chronic obstructive pulmonary disease (COPD) in western China.MethodAn interrupted time series was used to assess the impact of the ZMDP in 25 tertiary hospitals of Sichuan province, in which the policy was implemented in 2017. Monthly average total hospitalization expenses including drug expenses, medical service expenses and diagnosis expenses of COPD inpatients were analyzed with segmented regression model developed from January 2015 to June 2018.ResultsAfter the intervention of the ZMDP, the total hospitalization expenses of COPD patients significantly decreased immediately by 1022.06 CNY (P?=?.011). The post-policy long-term trend was decreasing by 125.32 CNY (P?<?.001) per month compared to the pre-policy period. The drug expenses kept downward trend both before and after the policy implementation. It had decreased by 46.42 CNY (P?<?.001) per month on average before the policy implementation and then dropped 1073.58 CNY (P?<?.001) immediately after the policy was implemented. Meanwhile, the medical service expenses had an increasing baseline trend of 14.93 CNY (P?<?.001) per month before the policy intervention, but it increased 197.75 CNY immediately after the policy was implemented (P?=?.011). The pre-policy period long-term trend of diagnosis expenses had increased by 25.78 CNY (P?<?.001) per month and decreased immediately by 310.78 CNY (P?=?.010). The post-policy trend was decreasing by 35.60 CNY (P?=?.001) per month compared to the pre-policy period.ConclusionOur study suggested that the ZMDP have been an effective intervention to curb the increase of hospitalization expenses for inpatients with COPD, especially the drug expenses in western region of China.

Dataset Information

Epidemiology and disease burden of complex wounds for inpatients in China: an observational study from Sichuan province.

Publications

Epidemiology and disease burden of complex wounds for inpatients in China: an observational study from Sichuan province.

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