County-level Hospitals In China Research Articles

19P Referral patterns among breast cancer patients in county-level hospitals in China

19P Referral patterns among breast cancer patients in county-level hospitals in China

Cluster randomized trial of influenza vaccination in patients with acute heart failure in China: A mixed-methods feasibility study.

Uncertainties about the efficacy of influenza vaccination for populations with heart failure (HF) in preventing cardiovascular outcomes, as well as lack of effective vaccination strategies, may contribute to low vaccine coverage rate (VCR) in China and globally. We assessed the feasibility of a strategy to promote influenza vaccines in patients hospitalized with acute HF in China and to inform the design of a hybrid effectiveness-implementation cluster randomized trial to evaluate this strategy on mortality and hospital re-admission. We conducted a cluster randomized pilot trial involving 11 hospitals in Henan Province in China, with mixed-methods evaluation between December 2020 and April 2021. A process evaluation involved interviews with 51 key informants (patients, health professionals, policy makers). The intervention included education about influenza vaccination and availability of free vaccines administered prior to hospital discharge for HF patients, while usual care included attending community-based points of vaccination (PoV) for screening and vaccination. Implementation outcomes focused on reach, fidelity, adoption, and acceptability. Recruitment rates were assessed for trial feasibility. Effectiveness outcomes were influenza VCR, HF-specific rehospitalizations and mortality at 90 days. A total of 518 HF patients were recruited from 7 intervention and 4 usual care hospitals (mean of 45 participants per hospital per month). VCR was 89.9% (311/346, 86.1-92.8%) in the intervention group and 0.6% (1/172, 0.0-3.7%) in the control group. The process evaluation demonstrated reach to patients with lower socioeconomic and education status. There was good fidelity of the intervention components, with education and PoV set up processes being adapted to local hospital workflow and workforce capacity. Intervention was acceptable and adopted by patients and health professionals. However, outside of a trial setting, concerns were raised around vaccination reimbursement costs, workforce accountability and capacity. The intervention strategy appears feasible and acceptable for improving VCR in HF patients at county-level hospitals in China. Trial registration: This pilot trial is registered with the acronym PANDA II Pilot (Population Assessment of Influenza and Disease Activity) at ChiCTR.org.cn (ChiCTR2000039081).

A survey on the practice of bronchoscopy in county-level hospitals of China

Objective: To investigate the bronchoscopy resource allocation and technology application in county-level hospitals in China. Methods: A cross-sectional survey was conducted. In 2021, 12 provinces were sampled from all provinces in China according to the regional Gross Domestic Product (GDP) and the number of counties, in which a total of 291 county-level hospitals were randomly enrolled. Two county-level hospitals which carried out bronchoscopy technology in each province were randomly sampled to investigate the status of bronchoscopy resources, technical application, decontamination and anesthesia by using questionnaires. Independent sample t test or two related sample nonparametric test were used for comparison between groups. Spearman correlation analysis was used to explore the correlation. Bilateral P<0.05 was considered statistically significant. Results: According to the sampling results, it was estimated that in the county-level hospitals, the proportion of those performing bronchoscopy was 11.4% (9.9%, 13.8%), which was significantly correlated with the population in the province (r=0.64, P=0.025) and the regional GDP (r=0.65, P=0.025).The 24 county-level hospitals interviewed were equipped with (1.6±1.0) bronchoscopes on average, and the number of hospitals with electronic bronchoscopes and fiberoptic bronchoscopes was 22 (91.7%) and 6 (25.0%), respectively. Six (25.0%) hospitals performed bronchoscopy every working day. Twelve (50.0%) hospitals had relatively permanent physicians and nurses. All operating doctors had received special training. There was a significant increase in the number of bronchoscopy cases per hospital in 2020 compared to 2019 [140(70, 335) vs. 100(29, 254), P=0.001]. All hospitals used standard cleaning and sterilization workbenches, cleaning agents and disinfectants. Surface anesthesia was available in 24 hospitals, and bronchoscopy techniques under sedation and analgesia were performed in 10 (41.7%) hospitals. Atropine was still used to prevent airway secretions in 2 (8.3%) hospitals,although not recommended by guidelines. Conclusions: There was a large gap between the current status of bronchoscopy technology in county-level hospitals and the standards of the National Health Commission, together with regional disparities. Bronchoscopist training in the standardization and the decontamination work met the requirements. In some hospitals, the use of complementary medicines was not standardized or the sedatives were not given routinely according to the guidelines. We should promote the popularization and standardization of bronchoscopy technology, and strengthen the allocation of related resources in China's county hospitals.

Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study

ObjectivesSince the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist.DesignWe applied the meta-frontier and slacks-based measurement-undesirable...

Mediating role of coping styles on anxiety in healthcare workers victim of violence: a cross-sectional survey in China hospitals

ObjectiveThe purposes of this study were to evaluate the rate of workplace violence in county hospitals in China and its impact on healthcare workers and to explore the relationship between...

Association of Hospital-Level Differences in Care With Outcomes Among Patients With Acute ST-Segment Elevation Myocardial Infarction in China

The incidence of acute myocardial infarction has increased over the past decades in China, and management challenges include an unbalanced economy, disparate resources, and variable access to medical care across the nation. To examine the variations in care and outcomes of patients with ST-segment elevation myocardial infarction among 3 levels of hospitals in the typical Chinese public hospital model. This cross-sectional study used data from the China Acute Myocardial Infarction Registry to compare the differences in care and outcomes among patients at 108 hospitals from 31 provinces and municipalities throughout mainland China. Participants included patients with ST-segment elevation myocardial infarction directly admitted to hospitals between January 2013 and September 2014. Data analyses were performed from June 2015 to June 2019. Care in province-level, prefecture-level, or county-level hospitals in China. The primary outcome was in-hospital mortality. Secondary outcomes included presentation, treatments, and major complications. A total of 12 695 patients (9593 men [75.6%]; median [interquartile range] age, 63 [54-72] years) were included; 3985 were at province-level hospitals, 6731 were at prefecture-level hospitals, and 1979 were at county-level hospitals. Compared with patients admitted to province-level hospitals, those admitted to prefecture-level and county-level hospitals were older (median [interquartile range] age, 61 [52-70] years vs 63 [54-72] years and 65 [57-75] years) and more likely to be women (815 women [20.5%] vs 1620 women [24.1%] and 667 women [33.7%]). Patients in prefecture-level and county-level hospitals were less likely to use ambulances compared with patients at province-level hospitals (11.6% [95% CI, 10.8%-12.4%] and 12.0% [95% CI, 10.6%-13.5%] vs 19.4% [95% CI, 18.1%-20.7%]; P < .001) and were less likely to experience early presentation, with onset-to-arrival times less than 12 hours for 75.3% (95% CI, 73.9%-76.6%) of patients at province-level hospitals, 70.8% (95% CI, 69.7%-71.9%) of patients at prefecture-level hospitals, and 69.8% (95% CI, 67.7%-71.8%) of patients at county-level hospitals (P < .001). The rates of reperfusion therapy were significantly lower in low-level hospitals (54.3% [95% CI, 53.1%-55.5%] for prefecture-level hospitals and 45.8% [95% CI, 43.6%-48.1%] for county-level hospitals) compared with province-level hospitals (69.4% [95% CI, 67.9%-70.8%]; P < .001). There was a progressively higher rate of in-hospital mortality at the 3 levels of hospitals: 3.1% (95% CI, 2.6%-3.7%) for province-level hospitals, 5.3% (95% CI, 4.8%-5.9%) for prefecture-level hospitals, and 10.2% (95% CI, 8.9%-11.7%) for county-level hospitals (P for trend < .001). After adjustment for patient characteristics, presentation, hospital facility, and treatments, the odds of death remained higher in prefecture-level (odds ratio, 1.39 [95% CI, 1.06-1.84]) and county-level (odds ratio, 1.43 [95% CI, 0.97-2.11]) hospitals compared with province-level hospitals (P for trend = .04). These findings suggest that there are significant variations in care and outcomes of patients among the 3 levels of hospitals in China. More efforts should be made to address the identified gaps, particularly in the prefecture-level and county-level hospitals. This work can inform national quality improvements efforts in China and in other developing countries.

Supervised Analysis of Hepatitis C Virus RNA-Positive Case Reporting in County-Level Hospitals - China, 2013-2018.

What is already known on this topic? To understand the status of the diagnosis and reporting of hepatitis C and standardize the reporting of hepatitis C cases in county-level hospitals, we conducted the first supervised analysis of hepatitis C cases in county-level hospitals in China from 2013 to 2018, covering all provincial-level administrative divisions (PLADs) except Tibet. What is added by this report? Through 6 years of supervision, we have obtained key data such as the nucleic acid detection rate and positive rate of hepatitis C virus (HCV) antibody positive cases in our county-level hospitals, the report rate and accuracy of HCV RNA positive cases, and standardized and improved the hepatitis C case reporting in county-level hospitals to improve data quality and provide data support for the judgment and estimation of hepatitis C in China. What are the implications for public health practice? By strengthening the management and supervision of hepatitis C case reporting, the reporting rate and accuracy of HCV RNA positive cases in county-level hospitals in China had been greatly improved. By combining the number of HCV antibody tests and the number of viral nucleic acid tests in medical institutions around the country, it was possible to effectively assess the current status of hepatitis C in China and to provide a scientific basis for the development of hepatitis C prevention and treatment measures.

Epidemiology of Clostridium difficile in a County Level Hospital in China

Background: The incidence of Clostridium difficile infection (CDI) has markedly increased over the past decade. Although its epidemiology has been previously investigated in tertiary hospitals, no studies have investigated the prevalence of CDI in county level hospitals in China. Objectives: This study aimed at describing the molecular characteristics of toxigenic C. difficile isolated from a community level hospital and evaluating physicians’ knowledge on CDI. Methods: We conducted a 15-month study at a country level hospital to characterize clinical isolates of C. difficile. A total of 61 toxigenic strains were isolated including 54 strains (88.5%), with both tcdA and tcdB genes positive and the remaining positive for the tcdB gene alone. Results: No binary toxin was detected. The toxigenic strains were found to be susceptible to vancomycin and metronidazole and exhibited high levels of resistance to clindamycin, levofloxacin, erythromycin, and ciprofloxacin. The most toxigenic C. difficile isolate was obtained from the gastroenterology and infection ward. Additionally, 13 sequence types (STs) were identified; ST-54 (32.8%), ST-3 (16.4%), ST-35 (13.1%), and ST-37 (11.5%) were the most common types. Conclusions: The results of the present study indicate that CDI may be a common problem, and large-scale multicenter studies are required to reveal the actual extent of the burden of CDI in county level hospitals.

Analysis on the size and income of off-staff medical workers at county-level hospitals in China

Objective To learn the size and income of off-staff medical workers in a survey of public county-level general hospitals in China. Methods Human resources investigation of public county-level general hospitals, with SPSS data analysis of the outcomes. Results From 2011 to 2013, the proportion of off-staff medical workers increased from 31.44% to 36.69%, of whom the highest proportion was found in China's western region, accounting for 40.69%; the ratio of off-staff practicing physicians increased from 14.24% to 16.64%, of whom China's central region accounted for 19.92%; the ratio of off-staff nurses increased from 43.03% to 49.77%, of whom China's western region accounted for 55.88%. In 13.7% of the hospitals, income of off-staff medical workers was less than a half of that for permanent staff; 41.32% and 26.31% of the hospitals surveyed were fully covered with social insurance and housing fund account respectively. Conclusions Off-staff labor is a distinct feature at such hospitals, making imperative a HR system reform of public hospitals.The discriminative income and welfare between permanent and off-staff medical workers calls for a fundamental change to the income and welfare system. Key words: County-level general hospitals; Medical workers; HR management; Welfare; Off-staff

Providers' HIV-related avoidance attitude and patient satisfaction.

This article explores the associations between medical care providers' attitudes towards patients living with HIV (PLH) and the service satisfaction reported from general patients. Data were collected from 40 county-level hospitals in China, including 1760 service providers and 1000 patients receiving medical services from the hospitals. Provider and patient assessments were conducted by self-administered questionnaires and face-to-face interviews, respectively. Random-effect regression models were used to examine relationships between the providers' avoidance attitudes and patient satisfaction at the hospital level while taking into account variations in demographics and professional experience within each hospital. Service providers' avoidance attitudes towards PLH were negatively associated with general patients' satisfaction with service providers at the hospital level. The relationship was strong and significant whether or not adjustments were made for background characteristics. Medical care providers' stigmatizing attitudes towards PLH could be a reflection of the providers' general outlook with all patients. This study underscores a broader focus for HIV-related stigma reduction interventions in medical settings at both individual and institutional levels, targeting attitudes towards both patients with HIV/AIDS and the general patient population.