Healthcare Facilities In China Research Articles

Effectiveness and Safety of Pyrotinib-Based Therapy in the Treatment of HER2-Positive Breast Cancer Patients with Brain Metastases: A Multicenter Real-World Study

BackgroundApproximately 30% to 50% of patients with human epidermal growth factor receptor 2-positive metastatic breast cancer develop brain metastasis (BMs). Pyrotinib has shown promising efficacy in these patients. However, real-world evidence supporting its use is scarce. Therefore, we evaluate the efficacy and safety of pyrotinib-based regimens in the real world. Materials and MethodsWe enrolled patients with BMs from various healthcare facilities in China's Shandong region and used an updated breast-graded prognostic assessment (breast-GPA) to predict survival outcomes. ResultsEfficacy and toxicity were assessed in 101 patients. Overall, the median progression-free survival (PFS) was 11.0 months (95% CI, 7.6-14.4 months). PFS was shorter in patients with a breast-GPA of 0 to 2.0 (P< .001). Previous treatment with pertuzumab plus trastuzumab (P = .039) and varying numbers of BMs (P = .028) had a significant positive correlation with PFS. Additionally, radiotherapy (P = .033) for BMs, especially pyrotinib concurrent with radiotherapy (P = .013), significantly prolonged the PFS. In patients with a breast-GPA of 0 to 2.0, a significant difference in PFS was observed depending on whether the brain was the first metastatic site (P< .001). Furthermore, a breast-GPA (0-2.0 vs. 2.5-4.0), and radiotherapy for BMs were found to be independent predictors of PFS. Overall, the objective response rate was 42.6%, while the disease control rate was 88.1%. Diarrhea emerged as the most common adverse event. ConclusionPyrotinib-based therapy is effective and tolerable in human epidermal growth factor receptor 2-positive metastatic breast cancer with BMs. Patients who underwent radiotherapy for BMs, particularly those who received pyrotinib concurrently with radiotherapy, exhibited a more favorable prognosis.

Implementing a continuous quality-improvement framework for tuberculosis infection prevention and control in healthcare facilities in China, 2017-2019.

Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019. Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics. Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services. TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.

Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019

The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China. We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness. Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected. Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China. This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].

A Nationwide Survey on Detection of Chlamydia trachomatis in Health Facilities in China.

This study evaluated the clinical laboratory capacity for the diagnosis of Chlamydia trachomatis (CT) in China to provide recommendations to improve the diagnostic capacity and quality of this clinically important sexually transmitted disease. An electronic questionnaire-based cross-sectional, survey study was conducted by the National Center for STD Control among different types of healthcare facilities in China from July to December 2021. The surveyed laboratory facilities were located in 332 cities in 31 provinces in China. A total of 4640 records from clinical laboratories were included in the data set for the final analysis. Less than half of the laboratories (41.6% [1931 of 4640]) performed the CT diagnostic test; of these, 721 laboratories (15.5% [721 of 4640]) carried out nucleic acid amplification test (NAAT) methods, and 1318 laboratories (28.4% [1318 of 4640]) performed antigen-based immunochromatographic assays. Most laboratories were equipped with biological safety cabinets (93.7% [4348 of 4640]), 49.2% (2283 of 4640) were equipped with fully automated nucleic acid extractors, and 55.2% (2560 of 4640) were equipped with polymerase chain reaction amplification instruments. The laboratories from Southern China or third-class hospitals (i.e., the highest rated hospitals) had the highest proportion using NAATs to diagnose CT among the surveyed health facilities. Advancing laboratories to use NAAT to detect CT should be phased step-by-step by different areas and levels of hospitals according to the current situation.

Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric.

The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.

Inappropriate antibiotic prescribing in primary healthcare facilities in China: a nationwide survey, 2017–2019

ObjectivesWe aimed to generate comprehensive estimates of the appropriateness of outpatient antibiotic prescriptions at primary healthcare facilities (PHFs) in China. MethodsBetween 2017 and 2019, we collected outpatient-visit prescriptions from 269 Chinese PHFs in 31 cities located in 6 provinces. Conditions that resulted in antibiotic use were classified into appropriate, potentially appropriate, and inappropriate using a well-established classification approach. We then assessed the magnitude, appropriateness, and costs of antibiotic prescribing, overall and by antibiotic classification group, diagnostic categories, and patient characteristics. ResultsOf all eligible 209 662 antibiotic prescriptions, 147 758 (70.5%) were inappropriate, which accounted for 66.8% (558.0/835.3 thousand US dollars) of costs for antibiotics. Upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis were responsible for 68.9% (101 744/147 758) of inappropriately antibiotic prescriptions. High inappropriate antibiotic prescribing rates were observed among children aged 0–5 years (78.5% (21 049/26 799)) and patients living in economically undeveloped areas (77.5% (38 430/49 587)). A total of 256 474 individual antibiotics were prescribed, of which 82.2% (210 885/256 474) were broad-spectrum antibiotics, with second-generation cephalosporins (15.1% (38 705/256 474)) and third-generation cephalosporins (14.6% (37 491/256 474)) being the most commonly prescribed subgroups. DiscussionOur findings highlight the excessive and inappropriate use of antibiotics in Chinese PHFs pending multidimensional efforts.

What facilitates hepatitis B and hepatitis C testing and the role of stigma among primary care patients in China?

Approximately 80% of primary healthcare facilities in China were ready to deliver hepatitis care services by 2021. This study aimed to assess hepatitis B and C test uptake, identify the factors associated with testing and determine the predictors of hepatitis stigma among primary care patients. We conducted a cross-sectional survey among patients seeking care in the family medicine and primary care unit of the University of Hong Kong-Shenzhen Hospital, China. Participants were 30 years or older and had not tested for HBV and HCV in the preceding 12 months. Test uptake was defined as self-reported previous HBV and HCV testing. Descriptive statistics, Chi-square test, forward multivariable logistic regression and stepwise multiple linear regression were conducted, and a p-value <.05 was deemed statistically significant. A total of 750 eligible patients completed the survey, and 54.5% (404 ± 0.9) were between 30 and 40 years old. Most participants were heterosexuals 98.0% (n=735), female 57.5% (n=431), married 78.3% (587) and earned ≤1500 USD per month 54.4% (n=408). A 66.1% (n=496) and 13.7% (n=103) self-reported previous HBV and HCV testing, respectively, and 62% (n=468) were vaccinated. HCV testing was associated with HBV testing (aOR=13.7, 95% CI:2.1-91.5); and HBV testing was associated with family history of HBV (aOR=2.4, 95%CI:1.1-5.5). Overall hepatitis stigma was about average and decreased with family history of HBV (p=.017). In conclusion, HCV testing uptake among primary care patients was low and needs to be further promoted. Integrating HBV and HCV testing interventions and fostering family-based support for disclosure could effectively improve testing uptake.

Vaccination coverage among COVID-19 prevention and control management teams at primary healthcare facilities in China and their attitudes towards COVID-19 vaccine: a cross-sectional online survey

ObjectiveTo investigate the COVID-19 vaccination coverage rate and differences among various COVID-19 prevention primary healthcare (PHC) facilities in China and understand their attitudes towards COVID-19 vaccine. These findings are helpful...

Prevention and control of COVID-19 by primary health care facilities in China: a field-survey-based qualitative study in three typical cities

BackgroundDuring the coronavirus disease 2019 (COVID-19) containment, primary health care (PHC) facilities inChina played an important role in providing both healthcare and public care services to community populations. The tasks of COVID-19 containment facilitated by PHC facilities were different among different regions and during different periods of COVID-19 pandemic. We sought to investigate the gaps on task participation, explore existing problems and provide corresponding solutions.MethodsSemi-structured face-to-face interviews with COVID-19 prevention and control management teams of PHC facilities were conducted. Purposive stratified sampling was used and 32 team members of 22 PHC facilities were selected from Wuhan (as high-risk city), Shanghai (as medium-risk city) and Zunyi (as low-risk city). Framework analysis was employed to analyze the transcribed recordings.ResultsThe main tasks of PHC facilities during the early period of the pandemic included assisting in contact tracing and epidemiological investigation, screening of populations at high-risk at travel centers/internals, house-by-house, or pre-examination/triage within PHC facilities; at-home/ centralized quarantine management; the work of fever sentinel clinics.Further analyses revealed the existing problems and suggestions for improvement or resolutions. Regular medical supply reserves were recommended because of the medical supply shortage during the pre-outbreak period. Temporarily converted quarantine wards and centralized quarantine centers could be used to deal with pressures on patients’ treatment and management of the febrile patients. Only after strict evaluation of nucleic acid testing (NAT) results and housing conditions, decision on quarantine at-home or centralized quarantine centers could be made. Settings of fever sentinel clinics at PHC facilities allowed fever patients with no COVID-19 infection risks for treatment without being transferred to fever clinics of the designed secondary hospitals. Psychological intervention was sometimes in need and really helped in addressing individuals’ mental pressures.ConclusionsDuring the COVID-19 containment, PHC facilities in China were responsible for different tasks and several problems were encountered in the working process. Accordingly, specific and feasible suggestions were put forward for different problems. Our findings are highly beneficial for healthcare teams and governments in handling similar situations.

Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China

BackgroundSpatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies.MethodsBased on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement.ResultsThe method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making.ConclusionsThe results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

Day Surgery Program at West China Hospital: Exploring the Initial Experience.

Healthcare facilities in China are facing increasing demands as the country has the fastest aging populations in the world. Day surgery can be utilized to address some of these demands. Benefits of day surgery include shortened hospital stay, decreased risk of hospital-associated infections, and increased cost efficiency. We present a retrospective study of eight years of day surgery data from West China Hospital, one of the largest hospitals in China, with an emphasis on an examination of the growth in day surgeries. We examined patterns of utilization of day surgery versus inpatient surgery (including types of surgeries performed in the Day Surgery Center and the ratio of day surgery versus elective surgery), as well as unplanned readmission and return to inpatient department rates, and a comparison of average costs and length of stay for day surgery versus hospital surgery.Day surgery has a safe and cost-effective way to alleviate the soaring healthcare demands in West China. There is potential opportunity to further address the ever-increasing demands on the healthcare system in this area by performing more complex surgeries as day surgeries. This article presents an effective organizational protocol and proposes a reliable medical quality assurance system, which prioritizes safety of the growing day surgery program; furthermore, it describes the factors and lessons learned from the successful implementation of a day surgery system.

PIN70 COST OF BLOOD AND BODY FLUID OCCUPATIONAL EXPOSURE MANAGEMENT IN CHINA

To determine the cost of management of occupational exposure to blood and body fluids (BBF) in healthcare facilities in China. A survey was conducted from August to October 2018, seeking general information concerning the management of occupational exposures to BBF and cost of the management process according to the protocol of each individual healthcare facility. In total, 211 healthcare facilities were surveyed using a stratified sampling method. The survey was conducted using a web-based form and protocol uploading system. The information collected includes direct cost such as laboratory testing fee, drug cost and medical service fee, and indirect cost such as wage, lost working time, injury compensation, psychological counseling time, etc. The cost of BBF post-exposure management varies greatly in infection status of the exposure source patients, the immune status of exposed employees, and the location and level of healthcare facilities. The mean values of the management cost are ¥5,936 ($897), ¥5,738 ($867), ¥4,508 ($681), ¥12,709 ($1,920) and ¥7,441 ($1,124) for HBV positive source, HCV positive source, TP positive source, HIV positive source and Unknown source, respectively. These numbers are higher than previously reported, and the variations among healthcare facilities are wide. The cost of managing BBF exposure is an economic burden in China. Some healthcare facilities, particularly those in rural areas, have insufficient post-exposure management. More effective prevention methods should be put in place to minimize exposure and cost.

Why patients prefer high-level healthcare facilities: a qualitative study using focus groups in rural and urban China

IntroductionDespite policy measure to strengthen and promote primary care, Chinese patients increasingly choose to access higher level hospitals. The resulting overcrowding at higher level hospitals and underutilisation of primary care...

Investigation on the Indoor Environment Quality of health care facilities in China

A one-year field measurement campaign was conducted in two healthcare facilities in China. Both the objective physical environment and subjective satisfactory survey data have been collected in inpatient and outpatient areas to evaluate the Indoor Environment Quality (IEQ) of Chinese hospitals. The standard compliance rate was utilized to evaluate the IEQ from the perspective of objective physical environment, while the satisfactory vote was used to evaluate IEQ subjectively. The overall satisfactory vote is just unsatisfactory for the 3 A hospital (3.00 out of 7-point scale) and just satisfactory for the 2 A hospital (3.86/7.00). The winter season was found to be the most unsatisfactory season, followed by summer, and this ranking is consistent in both hospitals. Among the four major aspects of IEQ, Indoor Air Quality was found to be the least satisfied. The correlation between objective physical environment and subjective satisfactory level is low in Chinese healthcare facilities. By comparing the 3 A and 2 A hospital, the satisfactory level of 3 A hospital is lower than that of the 2 A hospital, though the objective physical environment, reflected by the standard compliance rate, of 3 A hospital is not necessarily worse. The issue of over-crowdedness was believed to be the major factor for the low satisfactory level of 3 A hospitals.

Emergence of methicillin-resistant Staphylococcus aureus SCCmec type IV/V epidemic clones in a large teaching hospital in China

To investigate the staphylococcal cassette chromosome mec (SCCmec) genotype and molecular epidemiological characteristics of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) in a large teaching hospital in China. From January 2012 to December 2012, a total of 71 nonduplicate HA-MRSA were collected in a teaching hospital in Changsha, China. SCCmec types were determined by multiplex PCR, and Panton-Valentine leukocidin (PVL) gene was detected by PCR. The homology among the tested isolates was determined using pulsed-field gel electrophoresis (PFGE). Of the 71 HA-MRSA isolates, 49 (69.0%) carried SCCmec III, 10 (14.1%) carried SCCmec IV, 3 (4.2%) carried SCCmec V and 3 (4.2%) carried SCCmec II; the remaining 6 isolates were not typeable by PCR. Compared with patients having SCCmec I/II/III MRSA infections, those with SCCmec IV/V MRSA infections had a significantly younger age and a similar duration of hospital stay before the first MRSA-positive culture and total hospital stay. PVL genes were strongly associated with SCCmec type IV/V MRSA infections. HA-SCCmec IV/V MRSA strains showed a greater susceptibility to rifampicin, gentamicin, levofloxacin, ciprofloxacin, and tetracycline than HA-SCCmec I/II/III MRSA strains. The 13 HA-SCCmec IV/V MRSA isolates formed one large group at the 55% similarity level. Three PFGE clusters with a similarity index of 85% or more were identified, and unique PFGE profiles were observed in 4 isolates. This is the first report of HA-MRSA isolates carrying SCCmec V in Chinese hospitals. SCCmec types IV and V MRSA clones have emerged in Chinese hospitals, which urges more rigorous surveillance of their spread in healthcare facilities in China.

Building energy efficiency for public hospitals and healthcare facilities in China: Barriers and drivers

Maximizing energy efficiency within HHFs (hospitals and healthcare facilities) is a major challenge in the field of energy conservation. This paper studies the key barriers to the implementation of energy-efficient technologies in China's public HHFs. For this purpose, a preliminary survey was conducted at the Beijing Municipal Health Bureau in order to assess the energy conservation efforts being made at 20 public HHFs. In the survey, a list of specific barriers to energy efficiency was created and HHF staffs were asked to rank these barriers in the order of importance. The results show that the economic incentives, appropriate technology, as well as enforceable laws and regulations are insufficiently supported by the government, have become the most significant obstacles to the improvement of energy efficiency. To remedy this, policymakers should take a multipronged approach which addresses the hospitals, projects, and technical and operating procedures in order to encourage the full participation and support of all stakeholders involved. Specifically, the government should offer multilevel economic incentives and reward policies; establish practical mandatory targets for building energy efficiency; provide demonstrable best practices in terms of the project, techniques, and operating procedures; and promote awareness of the importance of property risk management.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis(TB).The TB prevention and treatment staff in health care facilities are responsible for the identification,diagnosis,treatment,supervision,and management of TB

Use and prescription of antibiotics in primary health care settings in China.

Appropriate antibiotic use is a key strategy to control antibacterial resistance. The first step in achieving this is to identify the major problems in antibiotic prescription in health care facilities, especially in primary health care settings, which is where most patients receive medical care. To identify current patterns of antibiotic use and explore the reasons for inappropriate prescription in primary health care settings in China. A total of 48 primary health care facilities in China were randomly selected from 6 provinces at various levels of economic development. Data for the years 2009 through 2011 from 39 qualifying facilities (23 city and 16 rural primary health care centers) were analyzed retrospectively. The study sample consisted of prescription records for 7311 outpatient visits and 2888 inpatient hospitalizations. General health center information, drug usage, disease diagnoses, and antibiotic use by outpatients and inpatients were surveyed. Cases of inappropriate antibiotic prescription were identified. Most staff in the primary health care facilities had less than a college degree, and the medical staff consisted primarily of physician assistants, assistant pharmacists, nurses, and nursing assistants. The median (range) governmental contribution to each facility was 34.0% (3.6%-92.5%) of total revenue. The facilities prescribed a median (range) of 28 (8-111) types of antibiotics, including 34 (10-115) individual agents. Antibiotics were included in 52.9% of the outpatient visit prescription records: of these, only 39.4% were prescribed properly. Of the inpatients, 77.5% received antibiotic therapy: of these, only 24.6% were prescribed properly. Antibiotics were prescribed for 78.0% of colds and 93.5% of cases of acute bronchitis. Of the antibiotic prescriptions, 28.0% contained cephalosporins and 15.7% fluoroquinolones. A total of 55.0% of the antibiotic prescriptions were for antibiotic combination therapy with 2 or more agents. In nonsurgical inpatients in cities, the mean (SD) duration of antibiotic therapy was 10.1 (7.8) days. Of the surgical patients, 98.0% received antibiotics, with 63.8% of these prescriptions for prophylaxis. Antibiotics are frequently prescribed in Chinese primary health care facilities, and a large proportion of these prescriptions are inappropriate. Frequent and inappropriate use of antibiotics in primary health care settings in China is a serious problem that likely contributes to antimicrobial resistance worldwide.