Chinese Public Hospitals Research Articles

The association between burnout, perceived organizational support, and perceived professional benefits among nurses in China

ObjectiveThis study sought to investigate the relationship between burnout, perceived organizational support (POS) and perceived professional benefits (PPB)as well as to explore factors associated with burnout among nurses in Chinese public hospitals. MethodsThe purposive sampling method was used to collect data from May 2023 through August 2023. A total of 1058 nurses from 5 public hospitals in Beijing, China, completed the questionnaires. The study used a cross-sectional survey design with data obtained using the Maslach Burnout Inventory (MBI-GS), Perceived Organizational Support Scale, and Perceived Professional Benefits Scale. Pearson correlation was used to examine the association between burnout and perceived organizational support with perceived professional benefits, while multivariate regression was used to investigate the specific factors related to both perceived organizational support and perceived professional benefits influencing burnout. ResultsEffective response rate was 1058(93.34 %). The total mean score of burnout was (3.024 ± 0.711), range = (1.59–4.50). Pearson correlation showed that the total mean score of burnout was negatively correlated with the total mean score of POS (r = −0.223, p < 0.01. Additionally, the total mean score of burnout showed a negative correlation with the total mean score of PPB. Multiple linear regression analysis showed that affective perceived organizational support (p < 0.01) and superior support (p < 0.01), sub-dimensions of perceived organizational support, were the main factors influencing burnout. There were no demographic disparities in burnout, except that nurses with ≤8 shift hours per week at night had significantly higher burnout scores (3.19 ± 0.72). ConclusionsThe study's participants experienced moderately high level of burnout. the findings highlight perceived organizational support and perceived professional benefit can be critical in alleviating burnout, medical institutions and nursing managers should undertake timely and effective interventions to boost organizational support and improve the degree of benefit from their profession. It is also recommended that adequate organizational support be prioritized, with a primary focus on improving affective organizational support and strengthening supervisor support.

The efficiency of residency training and health outcomes in China: Based on two-stage DEA and cluster analysis

To address the residency training performance and further explore its determinants, with the help of a unique dataset, our study calculated the efficiency of residency training and health outcomes in 18 Chinese tertiary hospitals from 2020 to 2021 using a two-stage data envelopment analysis (DEA) model given the two-stage characteristics of vocational training and clinical practice of residents. The results showed that the efficiency of the sample hospitals in both residency training and medical service provision was high, there are approximately 1/3 hospitals of sub-efficient in each stage, but the number of efficient units for assessing the residency training performance was slightly less than that for assessing the health outcome performance. All the decision-making units (DMUs) were clustered into four groups through K-means cluster analysis according to efficiency results. The results showed that there was an obvious inconsistency between the teaching goals and the health outcome goals of Chinese public hospitals. In some hospitals, the low residency pass rate resulted in the low efficiency in stage 1, while the redundant inputs in beds resulted in the low efficiency in stage 2. Residency training hospitals should strengthen their synergistic management in programs of residency training and health outcomes.

The Relationship between Safety Leadership and Safety Performance: An Empirical Study from Chinese Public Hospitals Nurse

The Relationship between Safety Leadership and Safety Performance: An Empirical Study from Chinese Public Hospitals Nurse

The impact of Chinese volume-based procurement on pharmaceutical market concentration.

Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.

Cost effectiveness of implantable cardioverter defibrillators for 1.5 primary prevention of sudden cardiac arrest in China: an analysis from the Improve SCA study

Objectives Implantable cardioverter defibrillator (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is underutilized in developing countries. The Improve SCA study has identified a subset of 1.5 primary prevention (1.5PP) patients with a higher risk of SCA and a significant mortality benefit from ICD therapy. From the perspective of China’s healthcare system, we evaluated the cost-effectiveness of ICD therapy vs. no ICD therapy among 1.5PP patients with a view to informing clinical and policy decisions. Methods A published Markov model was adjusted and verified to simulate the course of the disease and describe different health states of 1.5PP patients. The patient characteristics, mortality, utility and complication estimates were obtained from the Improve SCA study and other literature. Cost inputs were sourced from government tender prices, medical service prices and clinical experts’ surveys in 9 Chinese public hospitals. For both ICD and no ICD therapy, the total medical costs and quality-adjusted life-years (QALYs) were modelled over a lifetime horizon and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold recommended by China Guidelines for Pharmacoeconomic Evaluations, one to three times China’s GDP per capita (CNY85,698–CNY257,094) in 2022 Chinese Yuan. Results The incremental cost effectiveness ratio (ICER) of ICD therapy compared to no ICD therapy is 139,652 CNY/QALY, which is about 1–2 times China’s GDP per capita. The probability that ICD therapy is cost effective was 92.1%. Results from sensitivity analysis supported the findings of the base case. Conclusions ICD therapy compared to no ICD therapy is cost-effective for the 1.5PP patients in China.

The effect of occupational coping self-efficacy on presenteeism among ICU nurses in Chinese public hospitals: a cross-sectional study.

Nurses are the largest occupational group in the health field, with inestimable value in realizing universal health coverage, and nurses' physical and mental health has become an ordinary global reality. Compared with explicit absence, nurses' presenteeism has a more lasting impact and significant harm and loss. It has become an essential factor affecting nurses' physical and mental health, declining quality of healthcare services, and elevated healthcare-related risks. There is a lack of research exploring whether occupational coping self-efficacy influences nurses' presenteeism behavior, especially in less-developed regions of China. This study aimed to investigate the current status of ICU nurses' occupational coping self-efficacy and presenteeism in public hospitals in western China and to explore the impact of ICU nurses' occupational coping self-efficacy on presenteeism. A cross-sectional research design selected 722 ICU nurses in western China from January to February 2023 as survey respondents. A general information questionnaire, Occupational Coping Self-Efficacy Scale (OCSE-N), and Stanford Presenteeism Scale (SPS-6) were used. SPSS 21.0 software was used for statistical analysis. Pearson correlation analysis and multivariate hierarchical regression were used to explore the influence of ICU nurses' occupational coping self-efficacy on presenteeism. A total of 722 ICU nurses completed the questionnaire. The OCSE-N score of ICU nurses was (22.24 ± 6.15), and the SPS-6 score was (16.83 ± 4.24). The high presenteeism was 67.23%. Correlation analysis showed that in ICU nurses, OCSE-N total score was negatively correlated with SPS-6 total score (r = -0.421, p < 0.05), indicating that the higher the level of occupational coping self-efficacy, the lower the presenteeism. Multiple hierarchical regression analysis showed that occupational coping self-efficacy strongly predicted presenteeism, accounting for approximately 18.35% of the total variance. There is a correlation between ICU nurses' occupational coping self-efficacy and presenteeism, and nurses' occupational coping self-efficacy affects presenteeism differently. Managers should pay attention to nurses' occupational coping self-efficacy to promote nurses' presenteeism reduction.

Optimization Path for Management Decision-Making&amp;nbsp;of Chinese Public Hospitals Under the Background of Big Data

This study examines how Big Data might improve Chinese public hospital management. A comprehensive study examines how data diversity, storage efficiency, analytics tools, and information system complexity affect decision-making. A carefully selected quantitative dataset from Chinese public hospitals is used in the study. Analyses use structured medical records, semi-structured billing data, and unstructured patient comments. The sample size of 115 was chosen for statistical robustness and multiple regression analysis best practices, which recommend 10-20 observations per predictor variable for estimate. Multiple linear regression analysis highlights amazing correlations and stresses data diversity, storage efficiency, analytics tools, and information system sophistication in decision efficiency. The study helps healthcare executives and regulators understand the complex relationship between regression coefficients and modified R-squared value. Also evaluated are Chinese public hospitals' strengths and weaknesses. Strengths include data integration, analytics, and advanced information systems. The report emphasizes data quality and cultural transformation, which impact Big Data and decision-making. The report emphasizes data consumption and advanced analytics to empower healthcare decision-makers. This research informs Chinese public hospital strategic reforms to improve resource allocation, patient care, and efficiency. This paper demonstrates how Big Data can impact healthcare decision-making. It enriches academic discourse and guides healthcare stakeholders through modern management with relevant insights and practical advice.

The mediating role of perceived social support between work-family conflict and presenteeism among ICU nurses working shift work in Chinese public hospitals: A cross-sectional investigation.

Relative to explicit absenteeism, nurses' presenteeism has a more lasting impact and is more harmful and costly. This study aimed to explore the relationship between work-family conflict, perceived social support, and presenteeism and whether perceived social support mediates the relationship between work-family conflict and presenteeism among ICU nurses working on shifts in Chinese public hospitals. A cross-sectional research design was conducted from January to April 2023 in Sichuan Province, China. A total of 609 valid questionnaires were collected. The questionnaires contained information on demographic characteristics, the Work-Family Conflict (WFC) scale, the Perceived Social Support Scale (PSSS), and Stanford Presenteeism Scale-6 (SPS-6). Multiple stratified regression was used to explore the mediating role of perceived social support between work-family conflict and presenteeism. The mediating effect of perceived social support in work-family conflict and presenteeism was tested by Model 4 in the PROCESS 4.1 macro program in SPSS. A total of 609 nurses were included in this study, and the mean presenteeism score for ICU nurses working on shifts was 16.01 ± 4.293 (Mean ± SD), with high presenteeism accounting for 58.46%. After controlling for sociodemographic characteristic variables, work-family conflict was positively associated with presenteeism, explaining 7.7% of the variance. High perceived social support was related to low presenteeism, explaining 11.5% of the variance. Perceived social support mediated the association between work-family conflict and presenteeism among ICU nurses working on shifts. Chinese shift-work ICU nurses' high presenteeism scores deserve managers' attention. Work-family conflict is a significant predictor of nurses' presenteeism. Perceived social support is essential in improving nurses' work-family conflict and mediates the relationship between work-family conflict and presenteeism. Improving social support can reduce the impact of work-family conflict on presenteeism among nurses working shifts.

Effective analysis of job satisfaction among medical staff in Chinese public hospitals: a random forest model.

This study explored the factors and influence degree of job satisfaction among medical staff in Chinese public hospitals by constructing the optimal discriminant model. The participant sample is based on the service volume of 12,405 officially appointed medical staff from different departments of 16 public hospitals for three consecutive years from 2017 to 2019. All medical staff (doctors, nurses, administrative personnel) invited to participate in the survey for the current year will no longer repeat their participation. The importance of all associated factors and the optimal evaluation model has been calculated. The overall job satisfaction of medical staff is 25.62%. The most important factors affecting medical staff satisfaction are: Value staff opinions (Q10), Get recognition for your work (Q11), Democracy (Q9), and Performance Evaluation Satisfaction (Q5). The random forest model is the best evaluation model for medical staff satisfaction, and its prediction accuracy is higher than other similar models. The improvement of medical staff job satisfaction is significantly related to the improvement of democracy, recognition of work, and increased employee performance. It has shown that improving these five key variables can maximize the job satisfaction and motivation of medical staff. The random forest model can maximize the accuracy and effectiveness of similar research.

The Observation of Patient Satisfaction with Healthcare Services in Chinese Public Hospitals Through Patients Experiences in Jiangsu

Background: The objective of this study was to assess patients' overall satisfaction with and experiences with various aspects of healthcare in Chinese public hospitals. In addition, it aimed to find out the extent to which patients' experiences in public hospitals in urban and rural locations might be accountable for general satisfaction. Methods: The data were derived from questionnaires designed to serve the patient's satisfaction within hospitals regarding several aspects in ten primary and tertiary level public/private hospitals across Jiangsu (China). In 2019, a survey encompassing 1185 Patients, physicians, and paramedical staff members was conducted in ten public hospitals located in Jiangsu, China. Donabedian's model classified patient experience questions into six categories under the heading’s "structure" and "process," with overall satisfaction serving as the "outcome" category. To compare patient experiences and overall satisfaction in urban and rural settings, chi-square tests were employed. Results: For assessing the government healthcare system's staff, health insurance plans, and healthcare delivery units. The health status of the target populations was compared with that of the responders by looking at the demographic distribution, life expectancy, service delivery with and without favoritism, and health behaviors. Surveys from decision-makers, implementers, and the general public who experience policy revealed that a much higher proportion of respondents reported improvements and favorable changes in the majority of areas. The survey's findings indicate that patients are often more satisfied with urban hospitals as compared to rural hospitals. In Jiangsu, medical personnel are given nearly identical resources and facilities, albeit in transformed forms according to their jurisdiction. The process is how the policies are initiated, negotiated, formulated, communicated, implemented, and evaluated. Policy development is dominated by political factors impacting all aspects of policy, i.e., context, process, and content. Conclusions: Jiangsu has updated and implemented its health policy according to the demand of the day, which has noted the experiences of its workers, compassionate attitudes, and service delivery despite the workload. The province has put in place several insurance schemes, but there is an issue of dissatisfaction in rural health centers as compared to urban hospital patients that can be resolved by bringing awareness in the rural society; Jiangsu is also home to the best version of the Electronic Medical Record system. Furthermore, the satisfaction of urban hospital patients is comparatively high due to the excellent behavior of healthcare workers, the proper referral system, insurance availability, the duration of healthcare services, the out-of-pocket treatment cost, the resources availability at PHC centers, and the development of the healthcare system were also noted with noteworthy numbers.

Association of maternal age with adverse pregnancy outcomes: A prospective multicenter cohort study in China.

Although maternal age might affect pregnancy outcomes, it remains unclear whether this relationship is linear or curvilinear and if it differs between nulliparous and multiparous women. We aimed to characterize the relationship between maternal age and risks of pregnancy outcomes in a diverse sample of Chinese singleton pregnant women and to evaluate whether the relationship varied by parity. We based this prospective multicenter cohort study on data from 18 495 singleton pregnant women who participated in the University Hospital Advanced Age Pregnant Cohort Study, conducted in eight Chinese public hospitals from 2016 to 2021. We used restricted cubic splines to model nonlinear relationships between maternal age continuum and adverse outcomes, and performed multivariable log-binomial regression to estimate the adjusted relative risk (RR) and 95% confidence interval (CI). Among 18 495 singleton pregnant women (mean age 35.7, standard deviation (SD) = 4.2 years), maternal age was not related to postpartum hemorrhage or small for gestational age, but showed a positive, nonlinear relationship to gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum, placenta previa, cesarean delivery, preterm birth, large for gestational age, macrosomia, and fetal congenital anomaly, with inflection points around 35.6-40.4 years. Compared to women younger than 35 years, older women had higher risks of adverse pregnancy outcomes, except for postpartum hemorrhage and small for gestational age. The risks of placenta accreta spectrum, placenta previa, large for gestational age, and macrosomia were highest for women aged 40-44 years, and risks of gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, cesarean delivery, preterm birth and congenital anomaly were highest for those aged ≥45 years. Most risks were more pronounced in nulliparous than multiparous women (P for interaction <0.02). Delayed childbirth was related to increased risks of adverse pregnancy outcomes, especially for nulliparous women. Appropriate childbearing age, generally before 35 years, is recommended for optimising pregnancy outcomes.

Determinants of Work Engagement Among Doctors in Public Hospitals in China: A Conceptual Study

In China, doctors are not only the core of hospital development, but also the core of medical service system. The decisions and actions of doctors directly affect the quantity, quality, and price of health services. The mood of doctors will affect the work enthusiasm, which will affect the work engagement, and the work enthusiasm will directly affect the work efficiency and external service quality. The Chinese government hopes that every doctor in every hospital especially in public hospitals can have a good work engagement. It has become a very important issue to improve the work engagement of public hospitals in China. At present, many researches on work engagement are carried out under the western cultural background. In China, there are few researches related to the degree of involvement in China. Chinese work values are unique qualities of Chinese people. This conceptual study constructs a basic conceptual conceptual research framework through the JD-R model. By adding Chinese work values into the framework and proposing a new conceptual framework, the relationship between work demand, work resources and work engagement is adjusted. This conceptual study also provides valuable reference significance for future research on work engagement in Chinese public hospitals.

The impacts of medical insurance payment methods on medical bills and medical service quality: Evidence from Xiangtan, China

This study investigates the impact of Diagnosis-Related-Group (DRG) on medical expenses and medical service quality in Chinese public hospitals. We also examine how the effects of DRG vary among different hospital classifications. Using a unique dataset of hospitalization settlement and discharge information at the patient level, we apply a fixed-effects difference-in-differences (DID) model to assess the causal effects. Our research uncovers interesting findings on how public hospitals react to cost controls and quality improvement during the initial stages of DRG implementation. Our results reveal that DRG significantly reduces various medical costs but does not significantly affect the quality of care. Furthermore, we observe that DRG increases the burden on patients in Grade III hospitals and has a substantial negative impact on medical service quality, which contradicts the intended goals of the DRG payment reform. Our study provides insights from the hospital perspective and can serve as a reference for medical insurance payment reform in developing countries that are undergoing primary healthcare reform.

Patient satisfaction with humanistic nursing in Chinese secondary and tertiary public hospitals: a cross-sectional survey.

Humanistic care pertains to the abilities, attitudes, and behaviors central to patient-centered care, contributing to patients' sense of safety and wellbeing. This study aimed to assess the satisfaction of patients with humanistic nursing care in Chinese secondary and tertiary public hospitals. A national cross-sectional survey was conducted across 30 provinces and 83 hospitals in China. Patient satisfaction with humanistic care was assessed using the Methodist Health Care System Nurse Caring Instrument (NCI), which encompasses 20 items across 12 dimensions. Each item was rated on a 7-point Likert scale, yielding a total score of 140. Multiple linear regression analysis was employed to identify factors associated with patients' satisfaction. Moderate satisfaction (mean score 91.26 ± 13.14) with humanistic nursing care was observed among the 17,593 participants. Factors significantly associated with patient satisfaction included age, hospital type, presence of children, educational attainment, place of residence, family monthly income, and medical insurance type. The study findings highlight the importance of tailored interventions, evidence-based practice guidelines, and patient-centered care in improving patients' satisfaction with humanistic nursing care. Continuous emphasis on nursing education and professional development is crucial for enhancing humanistic care and patient satisfaction.

Identifying patient perceived values during outpatient encounters: an empirical study from Chinese public hospitals

BackgroundFocusing on patients’ perceived values is essential for patient-centered health care. Only by identifying the patient’s preferred values can we better meet their needs and provide them with valuable medical services. This study aimed to construct and validate a research model to obtain an overall quantification of patient value during outpatient encounters.MethodsThe development of the research model was based on the reviewed literature, and an initial theoretical framework was formed by an expert panel discussion. A scale questionnaire for all the items was adapted from previous research related to patient value, verified using a presurvey, and thus used for data collection for this study. The structural equation model was used to determine and evaluate the research model of the values patients perceived during outpatient encounters.Results572 eligible respondents who completed outpatient visits from a typical public hospital in China participated in this study from November 2020 to February 2021. We constructed the patient perceived value (PPV) model to identify core values, which includes eight dimensions and 29 items in terms of functional value (installation, efficiency, price, service quality), emotional value (interactive, control), and social value (accessibility, image) from two subgroups of patient value outside and in the outpatient visit process. Cronbach’s alpha for the whole model was 0.950. The confirmatory factor analysis showed that the PPV model fits well, with a correlation of 0.83 between the two subgroups.ConclusionIt is essential to recognize the values based on patients’ perceptions and experiences throughout the entire visit process. Our findings offer targeted insights for healthcare administrators, enabling them to holistically optimize outpatient service processes and continually enhance the quality of outpatient medical services from the patient’s perspective.

Machine learning and statistical models for analyzing multilevel patent data

A recent surge of patent applications among public hospitals in China has aroused significant research interest. A country’s healthcare innovation capacity can be measured by its number of patents. This paper explores the link between the number of patents and ten independent variables. Multicollinearity was carefully detected and removed by using the variable selection method and LASSO regression, respectively. The Poisson model and the negative binomial model were proposed to analyze the patent data. Three goodness of fit tests, the Pearson test, the deviance test, and the DHARMa non-parametric dispersion test, were conducted to investigate if the model has a good fit. After discovering four clusters by conducting agglomerative hierarchical clustering, these two models were replaced by the negative binomial mixed model. The likelihood ratio test was used to determine which model is more appropriate and the results reveal that the negative binomial mixed model outperforms both the Poisson model and the negative binomial model. Three variables, number of health technicians per 10,000 people, financial expenditure on science and technology as well as number of patent applications per 10,000 health personnel, have a significantly positive relationship with the number of patents in Chinese tertiary public hospitals.

How does patient-centered hospital culture affect clinical physicians’ medical professional attitudes and behaviours in Chinese public hospitals: a cross-sectional study?

BackgroundAn increasing number of studies on physicians’ professionalism have been done since the 2002 publication of Medical Professionalism in the New Millennium: A Physician Charter. The Charter proposed three fundamental principles and ten responsibilities. However, most studies were done in developed countries, and few have been done in China. Additionally, few studies have examined the effect of patient-centered hospital culture (PCHC) on physicians’ professionalism. We aimed to investigate physicians’ medical professionalism in public hospitals in China, and to assess mediating effect of professional attitudes in the relationship of PCHC with professional behaviours.MethodsSelf-administered questionnaires including professional attitudes (20 items) and behaviours (10 items) survey and PCHC scale (22 items) were given to clinical physicians in five public hospitals, China. The mediating effect of professional attitudes in the relationship of PCHC with professional behaviours was tested.Result232 valid questionnaires were collected. More than 90% (208) respondents agreed with 15 of 20 specific statements on medical professionalism. As for the responsibility of improving quality of care, 54 (23%) respondents disagreed with reporting of incompetent colleagues and as for the responsibility of maintaining professional competence, 49 (21%) disagreed with recertification. More than 185 (83%) respondents reported that they sometimes, usually, or always showed the four positive behaviours on the questionnaire, and 173 (77%) reported that they never showed the six negative behaviours. Mediating effect analysis revealed that two dimensions of PCHC (i.e. value/institution culture and behaviour/material culture) had a significant positive impact on physicians’ professional behaviour, and professional attitude played a complete mediation role between them, but another dimension of PCHC (i.e. negative evaluation of hospital) directly affected professional behaviour without influencing professional attitude.ConclusionChinese physicians showed positive professional attitudes and behaviours. Different dimensions of PCHC affected physicians’ attitudes and behaviours in different ways.

Analysis of Influencing Factors and Demand Forecast of Single Disease Demand in Chinese Public Hospitals

Objectives: In this study, we examine influencing factors and demand forecast of single disease demand in Chinese public hospitals. Methods: We conducted a preliminary screening of the literature, according to a literature search strategy and inclusion and exclusion criteria. Related Chinese and English articles between 2000 and 2022 were searched in the Chinese National Knowledge Infrastructure, Wanfang, PubMed, and Elsevier databases and Google Scholar. The Jadad literature scoring mechanism was used, and Stata/SE version 12.0 software was used to perform a meta-analysis of the effect size of literature statistics. The outcome index was the 2-week visit rate. Results: We included 13 articles for meta-analysis. Their combined effect size and 95% confidence interval for chronic disease, age, gender, economic factors, medical insurance form and education level were 3.43 (2.26, 5.51), 2.53 (1.74, 3.68), 1.3 (1.16, 1.46), 2.31 (1.16, 4.61), 3.2 (2.98, 3.45) and 1.35 (1.14, 1.6), respectively. Results revealed that for patients with chronic diseases, those>60 years of age and families with better economic conditions and higher levels of education correlated with a higher demand for medical services among families with medical insurance for urban residents. Conclusion: Using meta-analysis, we analyzed the factors that affect the demand for medical services in China. From demographic and economic factors, national medical insurance policies and residents' health status, we analyzed the relationship between patients with a single disease and other factors. With respect to the influence of medical service demand, relevant departments should take effective measures to increase medical service demand according to the influencing factor of the 2-week visit rate and simultaneously provide scientific theoretical guidance for medical reform.

The impact of organizational justice on psychological distress among Chinese public hospitals nurses: A cross-sectional study.

Few studies have explored the association between organizational justice and mental health, particularly in collectivist countries. Hence, the aim of the present study was to evaluate the impact of organizational justice on psychological distress and to discuss the findings in collectivist culture. A cross-sectional survey was conducted among nurses from public hospitals in western of China, July 2022, which followed the STROBE guidelines. This study used Chinese versions of the Organizational Justice Scale and Kesseler Psychological Distress Scale to assess the perceptions of organizational justice and mental health levels, respectively. A total of 663 nurses completed the questionnaires. The psychological distress of university-educated and low-income nurses was poor. There was a moderately positive relationship between organizational justice and psychological distress (R = 0.508, P < .01), indicating that the greater level of organizational injustice, the poorer mental health. Hierarchical regression analysis showed that organizational justice was an strong predictor of psychological distress, accounting for approximately 20.5% of the psychological distress. The findings of this study highlight the importance of interpersonal injustice and distributive injustice on psychological distress specific in Chinese culture, suggesting that nursing management or leaders should notice that the most being taken seriously by nurses is their recognition and respect for subordinate, meanwhile, alerting nurses, in some sense, a negative relationship with leaders as a kind of workplace bullying could harm their mental health. The promulgation of organizational justice policy to protect employees from the government and the real role of employee labor union organizations are urgently needed.

A Study on the Factors Influencing the Knowledge Hiding of Nurses in Chinese Public Hospitals: A Test of Mediating Effects Based on Psychological Ownership of Knowledge

Aim: It was designed to assess the current state of knowledge hiding behavior of nurses in Chinese public hospitals, to conduct an intensive study of the factors influencing nurses' knowledge hiding behavior and to construct a mediating effect model. Subjects and Methods: Quantitative cross-sectional descriptive design was used. A self-administered general information questionnaire was applied, and well-established scales included the Knowledge Hiding Scale, the Psychological Ownership of Knowledge Scale, the Job Insecurity Scale, and the Positive Emotional Climate in Teams Scale. Data was collected virtually by using the online Questionnaire Star. A non-probability, purposive sampling technique was used for a survey of 719 clinical nurses in Chinese public hospitals. Results: The total knowledge hiding score of 719 clinical nurses was (15.76±9.412). Clinical nurses' knowledge hiding behavior was positively correlated with psychological ownership of knowledge and job insecurity (r=0.574, P<0.01; r=0.309, P<0.01) and negatively correlated with positive emotional climate of the team (r=-0.194, P<0.01). Bootstrap test results showed that the 95% CI of the indirect effect of psychological ownership of knowledge between job insecurity and knowledge hiding was 0.075 to 0.186, with a significant mediating effect, which accounted for 55.31% of the total effect. Conclusion: Team emotional climate and job insecurity are influential factors in nurses' knowledge hiding behavior, where job insecurity has an indirect positive effect on knowledge hiding through psychological ownership of knowledge. Healthcare organizations can reduce the knowledge hiding behavior of clinical nurses and achieve knowledge sharing within the organization by breaking the psychological ownership of clinical nurses' knowledge and creating a multidimensional and safe work environment.