With the establishment and development of regional healthcare big data platforms, regional healthcare big data is playing an increasingly important role in health policy program evaluations. Regional healthcare big data is usually structured hierarchically. Traditional statistical models have limitations in analyzing hierarchical data, and multilevel models are powerful statistical analysis tools for processing hierarchical data. This method has frequently been used by healthcare researchers overseas, however, it lacks application in China. This paper aimed to introduce the multilevel model and several common application scenarios in medicine policy evaluations. We expected to provide a methodological framework for medicine policy evaluation using regional healthcare big data or hierarchical data.
ObjectiveTo explore the clinical effectiveness of two kinds of treatment methods to nurse wound after tracheotomy. MethodsWe collected 108 cases and randomly divided them into two groups between March 2012 and May 2013. The experimental group (n=52) received tracheotomy care with PermaFoam dressing, while the control group (n=56) was treated with traditional sterile absorbent gauze. We analyzed the differences in terms of infection of wound, errhysis and frequency of dressing changes between the two groups. ResultsThe experimental group had a lower rate of wound infection than the control group (P<0.05). Moreover, the experimental group was superior to the control group in the total number of dressing changes, wound redness and oozing (P<0.05). ConclusionPermaFoam dressing can reduce wound complications and frequency of dressing changes effectively. It is easy to operate, and can reduce the workload of clinical nursing, and deserves clinical application.
ObjectiveTo investigate the effect of 5% dextrose intravenous infusion for phlebitis caused by amiodarone. MethodsA total of 136 patients treated in our hospital between June 2011 and March 2012 were randomly assigned into control group with 63 patients and intervention group with 73 patients. The control group was administrated 600 mg amiodarone with 15 drops/minute intravenous injection once daily, for 3 days, while for the intervention group patients, we added 5% dextrose solution infusion in the same channel at the same time. ResultsPhlebitis occurred in 22 patients (34.9%) in the control group, while the intervention group had only 11 (15.0%) (χ2=7.252,P=0.007). ConclusionInfusion of 5% dextrose solution can significantly reduce the occurrence of phlebitis caused by amiodarone.
ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.