Research On Operation Effect Of Day Surgery In Y Eye Hospital Based On The Theory Of Value-based Health Care

Objective:Day surgery has been implemented as a measure to improve the quality of medical services.Is the safety and effectiveness of surgery guaranteed? What factors affect the service quality of daytime surgery deserve further study.Based on the theory of value medical treatment,this study carries out quantitative and qualitative analysis of Y eye hospital.According to the theoretical connotation,it focuses on analyzing the quality and cost,exploring the effect of day surgery in the hospital since its implementation,clarifying the main problems existing in the process of development,and confirming the value of day surgery.Methods:1.The methods of data collection(1)Literature reviewData include literature and second-hand data.The literature comes from CNKI,WANFANG and VIP,with "day surgery","effect evaluation","ITS","cost-effect" and "health economic evaluation" as titles or keywords.Foreign literature mainly comes from Pubmed,Web of science,BAILIAN and other databases.Second-hand data include the policies,plans and health statistic report issued by the state and Shanxi province.(2)Questionnaire surveyThrough questionnaire survey and on-the-spot investigation,we learn about the development of day surgery in Shanxi Province,including the medical service mode,BedNum,the proportion of personnel(doctors,nurses,medical technicians,managers),the payment method of medical insurance,the amount of surgery,the difficult and suggestions in the process.(3)Semi-structured InterviewsThe semi-structured interviews were mainly conducted with the managers of medicalinstitutions(hospital presidents,directors of daytime operation centers),doctors,nurses,health administrative departments(Health commission of Shanxi provincial hospital authority)and medical insurance departments.The main content of the interview included the difficulties in the promotion of day surgery,and their cognition and feelings.2.The methods of data compilationThe value-based health care theory origin and development was smoothed.Based on previous works which have been done,to investigate the effect of day surgery operating mode of related concepts and core ideas was collected from home and abroad.3.The methods of data analysis(1)interrupted time series analysisThe piecewise linear regression of ITS was used to analyze the changing trend of key indexes such as average hospitalization days of day surgery.(2)cost-effectiveness analysesThis study combins with the standpoint of this article-the patient-centered value medical concept,and carries out cost-effectiveness analyses from a patient's perspective.Results:(1)The overall average length of stay for the five diseases before carrying out day surgery was 5.19 d in Y Eye Hospital,after day surgery was 1.93 d,reducing 3.26 d,and the average length of stay showed a downward trend.The average length days of the five diseases in the initial stage were 5.748 d/m.The slope was-0.045,indicating that the average length days before carrying out day surgery showed a downward trend,reducing0.045 d/m(=-0.045,P<0.001);the average length of stay decreased by 3.534 d when carrying out day surgery policy,and the difference was statistically significant(P=0.004).(2)Complicated cataract,Entropion and trichiasis of eyelid,Rhegmatogenous Retinal Detachment(RRD)all showed good curative effect.The number of people who did not heal was 0,and the cure rate was 100%.There was no significant difference between the two groups(P>0.05).The cure rate of Metabolic cataract was 99.82% in day surgery and 97.31% in traditional surgery.The cure rate of Senile cataract surgery in day surgery is 99.74%,and that of traditional surgery is98.83%.The cure rate of day surgery for the two diseases is higher,and the cure rates are above 97%,with statistical difference(P<0.05).(3)The direct medical cost of traditional surgery for 5 diseases is higher,withstatistical difference(P<0.05).In terms of direct non-medical cost,the cost of traditional surgery for RRD is about 5 times.The cost of traditional surgery for cataracts,Complicated cataract,Entropion and trichiasis of eyelid is more than 2.5times.In terms of indirect medical cost,the difference between the two groups' cost for 5 diseases is about 1000 RMB.In terms of total medical cost,the average per capita total medical cost for patients with Entropion and trichiasis,Metabolic cataract,Complicated cataract,RRD and Senile cataract decreased respectively by67.82%,37.45%,34.74%,39.30% and 35.04%(P<0.05).The ICER of Metabolic cataract was-210239.24,and Senile cataract was-524735.67.Conclusion:This study analyzes the value of day surgery for 5 diseases in Y eye hospital from the view of value-based health care :on the premise of ensuring the curative effect of surgery,it reduces the hospitalization days and treatment costs,and fully shows the value of high-quality and low-consumption medical services.However,there are still deficiencies in the process of promotion,such as poor cognition of patients and their families,complicated medical record writing,reimbursement of outpatient examination expenses,postoperative rehabilitation and other issues.It is suggested that hospitals should establish themselves with culture and adhere to the basic principle of patient-centered.Set things up with quality and create an integrated service model.