Different Levels Of Hospitals Research Articles

Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system.

The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Clinical outcomes and economic evaluation of patient-centered care system versus routine-service system for patients with type 2 diabetes in Thailand

IntroductionPatient-centered care in diabetes is another approach for outcome improvement, yet the supporting economic and clinical evidence remains limited in Thailand. ObjectivesThis study compared health outcomes and cost-utility of implementing Patient-Centered Care Systems (PCCS) in a primary care setting vs. the Routine Service System (RSS) in a hospital setting. MethodsThe economic evaluation was performed using a randomized controlled study design. The participants aged ≥18 were enrolled from Phimai City in Nakhon Ratchasima Province, Thailand from June 2022 to February 2023. Totally, 309 well-controlled patients with initial care in a hospital were referred to receive the PCCS at the primary care setting or remained receiving the RSS in the hospital. Outcomes of different approaches such as fasting blood sugar, Hemoglobin A1c (HbA1c), direct medical costs, direct nonmedical costs and utility were prospectively collected at months 0, 3 and 6. Fisher's exact test, t-test or Wilcoxon signed-rank test were used to analyze data, whichever was appropriate. An incremental cost-effectiveness ratio was calculated, and various sensitivity analyses were performed. ResultsThe PCCS showed significantly reduced HbA1c (p < 0.001) and a greater number of patients with improved HbA1c (p < 0.001). The PCCS were a cost-saving strategy due to incurring lower total costs (60.15 vs. 73.42 USD) and gaining more quality-adjusted life-years (QALY)(0.340 vs. 0.330) compared with the RSS. With a ceiling ratio of 4,659 USD/QALY, the PCCS had a 94.6 % probability of being cost-effective. ConclusionThis finding indicated that the PCCS in a primary care setting was a cost-saving strategy by lowering cost, providing a higher quality of life and improving glycemic control compared with the RSS in a hospital setting. However, generalizing the findings in a country as a whole, the economic evaluation of PCCS and RSS should be conducted among different levels of hospitals from all regions in Thailand.

Impact of Artificial Intelligence on Mammography Interpretation by Breast Radiologists, Non-Breast Radiologists, and Senior Residents

Background: Artificial intelligence (AI) is recognized to have tremendous potential to revolutionize breast cancer management through mammography. However, the extent of its impact on radiologists with different levels of experience remains largely unexplored. Therefore, this study aimed to comprehensively show how AI could assist radiologists of varying expertise including breast and non-breast radiologists, as well as senior residents, in performing mammogram interpretation.Methods: This retrospective study analyzed eligible mammograms from Cipto Mangunkusumo Hospital between January 2017 and March 2021. Mammographic readings were conducted independently by two breast radiologists, two from other subspecialties, and three senior residents, all blinded to clinical information. AI standalone performance, as well as radiologists with and without AI assistance, was measured. Results: The results showed that a total of 886 eligible mammograms were analyzed. AI standalone performance, assessed using ROC curve analysis, yielded an AUC of 0.946 (95% CI, 0.925–0.967) with sensitivity and specificity of 90.1% and 93.6%, respectively. AI assistance significantly improved the sensitivity and specificity of all radiologists, regardless of experience level, with a median increase of 19.4% (IQR, 10.4–33.5%) and 12.1% (IQR, 5.2–16.2%), respectively. Moreover, there was a trend toward a higher increase with AI assistance in dense compared to fatty breasts.Conclusions: AI proved to be a highly effective diagnostic supplement for radiologists across varying experience levels, specifically in non-breast radiologists, offering the potential to add even greater value in cases of dense breast tissue. The results were derived from a national referral tertiary hospital that generally received many breast cancer cases referred from other hospitals for further treatment. Therefore, further studies incorporating different levels of hospitals were needed.

Total Quality Management, Safety and Stakeholders Satisfaction: Model for Healthcare Administration

The health care industry has undergone turbulent change over the past decades. The industry and political leaders have grappled with several issues that impact access to care, quality of care, and the cost of care. The COVID-19 pandemic highlighted these challenges even more, as hospitals struggled to treat the overwhelming influx of patients and worked to prevent the spread of disease. For private hospitals, the challenge is even more overwhelming with a transition towards the VUCA (Volatile, Uncertain, Complex, Ambiguous) world of the healthcare landscape. The increasing rivalry of players in the private hospital industry demand that administrators drive the optimal performance of hospitals as well as the provision of high-quality, safe, effective, and efficient services amidst the high rivalry of players in the industry. For optimum medical services to be provided, managers and planners must have some knowledge of the hospital performance based on the relevant index. Therefore, it is important to identify the factors affecting the overall performance of the hospital. Today’s patients, like any other customers, are well informed, discerning, and demanding. This is not only because of the availability of extensive information about the variety of similar products and services available to them but also from the improved marketing capabilities of the hospital to introduce their best services by promoting their respective state-of-the art medical equipment and excellent hospital experience they can offer to patients. This situation necessitates the service provider strive to provide their customers with products and services of greater value. To effectively do this, hospitals must be consistent with what their patients need and want and are willing to pay for. Health care providers in turn, must be willing to provide service with quality and safety to ensure customer satisfaction (Medina, 2016). The study explored Total Quailty Management, safety, and stakeholder’s satisfaction: model for healthcare administration. More specifically, it describes the profile of respondents. For the doctors and employee respondents, the description was in terms of age, gender, civil status, educational level, annual income, job tenure, job position and TQM training. For patients, the description was in terms of age, gender, civil status, educational level, work industry, job position, annual income, length of hospital service experience and hospital services utilized. It determines Total Quality Management in terms of: policy and strategy documents availability, personnel attributes, protocols, guidelines and procedures, elements of quality and safety management systems, process and outcome evaluation and patient involvement. It determines safety in terms of: hospital’s surge capacity, infection control prevention measures, case management, human resources, diagnostic capability, and logistic and supply chain management. It determines customer satisfaction by considering patients, employees, and doctors in terms of: tangibility, reliability, responsiveness, assurance, empathy, and affordability. It tests the effects of the demographic profile of respondents on the agreement to TQM, Safety and Customer Satisfaction. It tests the relationship and interactions between three variables of interest using PLS-SEM. The structural model was examined to determine the relationships among the three variables that led to a mediation framework for healthcare administrators. The study employed two research designs - descriptive, and causal/explanatory designs. Participants were patients, employees, and doctors of the selected Level 2 and 3 hospitals based on the classification of the Department of Health in the Philippines with a total of 600 respondents, comprised of 200 patients, 200 doctors and 200 employees as supported by an accredited statistician through random sampling. The respondents came from ten private hospitals, three coming from South Luzon, two from Manila, three from North Luzon, one from Visayas and 1 from Mindanao. Result shows that there were two stakeholders for the study, the Employee/MD respondents, and the patient respondents. Majority of the respondents are from North Luzon region, operate in a level 2 hospital, work in a hospital that can accommodate 100 to 199 inpatients for full-time healthcare and accommodation in the hospitals, have been working for a hospital that has been operating for at least 10 years, 100 to 199 accredited doctors, work in a hospital that has at least 500 employees, employees are mostly medical doctors, have stayed with the same hospital for at least 10 years, mostly female employees, aged between 30 to 60 years old, married, postgraduate degree, professional or technical occupation, monthly house income of at least 100,000 pesos, have undergone TQM training, got their treatment in the South Luzon region, belong to healthcare industry, regular workers, receive 10,000 to 29,999 pesos for their monthly salary, experienced hospital services for 1 to 3 years, patients avail both inpatient services and outpatient services during their healthcare from the hospital. Stakeholders agree on all the dimensions and attributes of TQM. Policy and strategy documentation had the highest agreement score while elements of quality and safety management and process and outcome evaluation were given the lowest agreement score. More so they agree on all the dimensions of safety. Infection control and prevention and case management had the highest agreement scores while surge capacity got the lowest agreement score. Furthermore, they agree on all the dimensions of customer satisfaction. Assurance and empathy were given the highest agreement score while affordability was given the lowest agreement score.TQM and safety have a significant and direct effect on customer satisfaction. TQM has a moderate mediation between safety and customer satisfaction. The proposed mediation framework of total quality management between safety and customer satisfaction with multigroup analysis illustrates how each variable affects another variable. More so, safety has a significant effect on the TQM. The researcher recommends that the management may focus on a more intensive stratification and profiling of stakeholder and patients considering comparative analysis across the different levels of hospitals besides the regions. The hospital management staff may establish key results areas that are shared by departments that will enhance various discipline to work together for the improvement of the services rendered by the hospitals through an unbaissed quality audit department for a more efficient and effective management that will ultimately lead to the delight of stakeholders. The management staff may further promote awareness and visibility of quality promoters in the hospitals by creating a process and work teams to improve collaboration between healthcare workers and management for an integrated development policy through a more effective and efficient IT systems and the use of data to improve hospital policies. The hospitals under study may draw up facility plans and processes to ensure capacity to address surges of future pandemics by ensuring more competent since the hospitals within the study are valued for their ability to admit inpatients and prioritization depending on the situation at hand in the hospital. The researcher posited that the hospitals under study may invest more mechanisms, stations and graphics relating to infection control in the hospital to improve general sentiment for this attribute. Generate improvement for presence of psychosocial teams and availability of minimum number of personnel within the hospitals. The hospitals may include in their future provisions; adequate and convenient parking spaces, information brochures, improvement of appointed time, records retrieval, quality and affordable health care, competent health care practitioners with experiences and trainings, improved facilties, better safety culture, accurate billing charges, good feedback mechanism to ensure continuous improvement. Future researchers may review the dimensions of the variables under study and include other demographics not utilized in this study for a more comparative analysis.

Current situation and needs analysis of medical staff first aid ability in China: a cross-sectional study

ObjectivesWe aim to understand the current situation of the first aid ability and training needs of Chinese medical personnel to provide a scientific basis for formulating the contents and methods of emergency medical rescue training and thereby improve the first aid level of Chinese medical personnel.MethodsA cross-sectional survey was conducted between June 2022 and February 2023 using a two-stage cluster sampling method with a structured questionnaire sent to medical workers in 12 provinces in China. 14,527 questionnaires were included in this study. Data were collected on demographic characteristics, first aid knowledge and skills, and training needs. Variance analysis was used to compare the difference between the first aid ability and training needs of medical staff in different hospitals, and multiple linear regression analysis was carried out to evaluate first aid ability and training needs.ResultThe study included 6041 patients (41.6%) in tertiary hospitals, 5838 patients (40.2%) in secondary hospitals, and 2648 patients (18.2%) in primary hospitals. There were significant differences in the first aid ability and training needs of medical staff in hospitals of different levels (p < 0.001). The score of first aid knowledge and skills in tertiary hospitals was the highest (209.7 ± 45.0), and the score of training needs in primary hospitals was the highest (240.6 ± 44.0). There was a significant correlation between first aid ability and training needs score (p < 0.001). Multiple linear regression analysis shows that geographic region, age, work tenure, gender, job title, department, professional title, monthly income, and hospital level are the influencing factors of training demand.ConclusionMedical staff in primary hospitals generally have low first aid knowledge and skills and a strong willingness to train. Therefore, it is imperative to strengthen the training of first aid ability and research training strategies. The level of the hospital is closely related to the level of first aid, so it is necessary to recognize the commonalities and differences in medical staff’s demand for first aid knowledge and skills and carry out targeted education and training.

Construction and effect evaluation of a hierarchical training system for nosocomial infection based on hospitals at all levels

INTRODUCTION: Nosocomial infection is a critical global public health issue. The education of medical personnel can effectively enhance compliance with nosocomial infection protocols and reduce the incidence of such infections. However, the current training provided to third-party staff is inadequate, necessitating an urgent enhancement of their knowledge on nosocomial infection through effective and tailored training programs.&#x0D; OBJECTIVES: The objective is to establish a hierarchical training system for nosocomial infection, customized to meet the specific requirements of hospitals at all levels, and evaluate its efficacy.&#x0D; METHODS: A questionnaire survey was conducted among third-party staff members at hospitals of different levels to assess their understanding of nosocomial infection prevention measures. Based on the survey results, a hierarchical training system was developed for nosocomial infection among the participants. After the training, a post-training assessment was carried out to evaluate the participants' comprehension of nosocomial infections.&#x0D; RESULTS: A total of 561 third-party employees participated in the baseline hospital infection knowledge questionnaire. The baseline findings unveiled disparities in the extent to which third-party staff members across various tiers of medical institutions have mastered their knowledge on nosocomial infections. After undergoing hierarchical training, the deficiencies of hospitals at all levels have been rectified, thereby effectively enhancing the level of knowledge regarding nosocomial infections among third-party personnel. The results of multivariate analysis indicate that individuals with limited work experience should enhance their training in medical waste disposal and acquire a deeper understanding of personal protection measures related to nosocomial infections. Moreover, infrequent annual training sessions may impede the comprehension of nosocomial infection among third-party staff.&#x0D; CONCLUSION: The knowledge of hospital infection among third-party staff at all levels of medical institutions exhibits varying deficiencies. Implementing a hierarchical training approach is a meaningful strategy that effectively enhances the level of hospital infection knowledge among these staff members.

Factors Predisposing to Postdural Puncture Headache after Spinal Anaesthesia among Elective Caesarean Section Patients at Thika Level 5 Hospital, Kenya

Background: Postdural puncture headache (PDPH) is a common complication following spinal anaesthesia for Caesarean section (CS). There is little data on the incidence and its predisposing factors in low-income countries. The study aimed to investigate the incidence and factors predisposing patients to PDPH after a dural puncture during a planned Caesarean section under spinal anaesthesia at Thika Level 5 Hospital, Kenya.&#x0D; Methods: A cross-sectional study design was used. Pregnant women scheduled for planned Caesarean sections under spinal anaesthesia at Thika Level 5 Hospital were randomly recruited. Data was collected during the fourth quarter of 2021. Patient factors (age, BMI, bed rest, and previous history of PDPH), healthcare provider factors (qualification, experience, and the number of dural punctures), and equipment factors (size, design, and spinal needle orientation) were evaluated to determine predisposing factors for PDPH. Sample size obtained by the use of Fisher’s formula, resulting in a sample size of 103.&#x0D; Results: We found the incidence of PDPH at Thika Level 5 Hospital to be 24.5%. Patient and equipment factors were found to be associated with PDPH. Among the patient factors, high BMI was found to be significant (p = 0.039) while among the equipment factors, traumatic needle tip design (p = 0.049) and the perpendicular orientation of needle bevel (p = 0.022) were found to be associated with PDPH.&#x0D; Conclusion and Recommendations: We conclude that PDPH is a common complication following spinal anaesthesia for Caesarean section, and the incidence (24.5%) is relatively high at Thika Level 5 Hospital. High BMI, traumatic cutting spinal needle tip design and perpendicular orientation of the needle bevel are predisposing factors. Further research is needed to determine the predisposing factors of PDPH at different levels of hospitals in Kiambu County, and understand the specific mechanisms and measures to minimize the incidence PDPH

Agent-Based Modeling and Simulation (ABMS)on the influence of adjusting medical service fees on patients' choice of medical treatment

BackgroundWe explored the impact of medical service fee adjustments on the choice of medical treatment for hypertensive patients in Beijing. We hope to provide decision-making reference to promote the realization of hierarchical diagnosis and treatment in Beijing.MethodsAccording to the framework of modeling simulation research and based on the data of residents and medical institutions in Beijing, we designed three models of residents model, disease model and hospital model respectively. We then constructed a state map of patients’ selection of medical treatment and adjusted the medical service fee to observe outpatient selection behaviors of hypertensive patients at different levels of hospitals and to find the optimal decision-making plan.ResultsThe simulation results show that the adjustment of medical service fees can affect the proportion of patients seeking medical treatment in primary and tertiary hospitals to a certain extent, but has little effect on the proportion of patients receiving medical treatment in secondary hospitals.ConclusionsBeijing can make adjustments of the current medical service fees by reducing fees in primary hospitals and slightly increasing fees in tertiary hospitals, and in this way could increase the number of patients with hypertension in the primary hospitals.

Experience of cardiopulmonary resuscitation by healthcare professionals in emergency departments: A descriptive phenomenological study

BackgroundEmergency department healthcare professionals have the most contact with patients in cardiac arrest, and their physical and mental state has a significant impact on the quality of cardiopulmonary resuscitation and patient outcomes. However, there is limited research discussing the experience of resuscitation by emergency department healthcare professionals. AimTo explore the experiences of emergency department healthcare professionals in performing cardiopulmonary resuscitation. MethodsA descriptive phenomenological study. The study used purposive sampling and selected 9 nurses and 6 physicians from the emergency departments of four general hospitals of different levels in western China between May 2022 and October 2022. Semi-structured interview guides and face-to-face interviews were used to collect information. Colaizzi analysis was used to analyze the data. ResultsThe study identified 3 themes and 11 sub-themes. These themes and sub-themes include 1) emotional experience (A sense of achievement, A sense of powerlessness and trauma, Stress, Empathy, Psychological resilience strengthens), 2) cognitive growth (Understanding CPR rationally, Increasing concern for personal and family health, Mastering self-relaxation methods), and 3) the desire for continued development (Seeking professional development, Hoping for professional psychological assistance, Strengthening team support). ConclusionsThe experience of performing cardiopulmonary resuscitation by healthcare professionals in emergency departments is dynamic, with changes in mood and cognitive growth. Managers in hospitals should pay attention to their experiences and need at different stages of career development and actively carry out targeted cognitive guidance, skills training, and psychological support to help them achieve professional development and physical and mental health. At the same time, to promote the development of CPR for all, it is recommended that the authorities actively improve the public infrastructure for first aid and related policy protection.

Study on the influence of patient safety culture on the pain and turnover intention of Chinese nurses in adverse nursing events.

Exploring the influence of patient safety culture on nurses' pain and turnover intention the job as a second victim. The study employed a cross-sectional design. From July 2020 to August 2020, a convenience sampling method was used to select 1525 clinical nurses from hospitals of different levels in Shandong Province as the research subjects, and the general data survey method, patient safety culture scale and the assessment entries on pain in the second victim experience and support scale, using a convenience sampling method. Patient safety culture is an influencing factor that affects the second-victim pain and turnover intention. Among them, the non-punitive response to errors, open communication, cooperation between different departments, organizational learning and promotion has a statistically significant influence on the second-victim pain and turnover intention.

Assessing Patient Rights Awareness Among Healthcare Professionals in Rural Areas of a Less Developed Country Without an Official Patient Bill

Awareness of patients’ rights is critical in the provision of healthcare services to ensure protection of these rights and satisfaction of patients. A thorough assessment of patient rights awareness among the physicians and nurses in a rural area of an underdeveloped country was performed, to generate valuable information for possible curriculum adjustments in medical schools and to inform health administrators on the essence to improve the awareness of patient rights among healthcare professionals of these rural areas. 223 active physicians and nurses from the public and private hospitals of different levels in Tiko Sub-Division completed self-administered questionnaires. The study reveals poor knowledge of a patient’s right to make decision about the treatment option, right to refuse treatment and the right to receive medical care in an emergency before payment of the service, among physicians and nurses. Also, the overall patient rights awareness level among the respondents was rated 85%, which signifies an awareness level of standard but requires improvement. The result of this study suggests extended education of healthcare professionals about the rights of a patient, with emphasis on those with no or lower length of work experience. Also, the study further suggests adequate knowledge of patients’ rights and its importance be instilled in medical students of the undeveloped world, be known to, respected and implemented by health administrators and healthcare professionals.

Patient safety culture among healthcare professionals in Bhutan

Introduction: There is dearth of information regarding the status of patient safety culture in Bhutanese healthcare system. The aim of the study was to assess the baseline patient safety culture among the healthcare professionals working in different levels of hospitals in Bhutan. Methods: A cross-sectional study was conducted using the Hospital Survey on Patient Safety, version 2 (HSOPS2) questionnaire in 2021 in six District Hospitals (DHs), two Regional Referral Hospitals (RRHs), and one National Referral Hospital (NRH) in Bhutan. A total of 782 healthcare professionals were recruited into the study. EpiData version 3.0 and Statistical Package for Social Science (SPSS) version 28.0 were used to process data and conduct the statistical analysis on survey data including descriptive statistics and validity and reliability of survey. The internal consistency reliability of each composite measure was assessed by calculating Cronbach’s alpha score. Results: The overall level of patient safety culture was 61.28% (95% CI: 113.26, 115.27) and the percentage scores for the ten patient safety dimensions ranged from 45.13% to 82.65%. The dimension, “Teamwork within the hospital units” had the highest positive score while the dimensions, “Staffing and work pace” and “Reporting patient safety events” had the lowest positive scores. Conclusions: The healthcare professionals working in hospitals in Bhutan had average patient safety culture. To improve patient safety culture, more emphasis should be given on human resource management, patient safety event reporting system, hospital management support for patient safety and quality improvement initiatives and creating an environment that promote just and learning culture. 

Management of the COVID-19 pandemic in Rhineland-Palatinate hospitals of all levels of care : Results of the COVID-19 Registry RLP.

The COVID-19 pandemic placed asignificant burden on the German healthcare system. Based on the experience of severe disease progression of the SARS-CoV‑2 infection from neighboring European countries in the early 2020s, with ICU overload and high mortality rates, efforts were made in Germany to increase the capacity of available ICU beds. Subsequently, all documentation and reporting focused on the ICU capacities for COVID-19patients. It was hypothesized that mainly afew large hospitals provided care for the majority of COVID-19patients. The COVID-19 Registry RLP of Rhineland-Palatinate documented SARS-CoV‑2 inpatients from daily mandatory queries of all hospitals throughout the pandemic from April 2020 to March 2023, distinguishing between patients in ICUs and normal wards. In its 18thCorona Ordinance, the state government required all hospitals to participate in the care of SARS-CoV‑2 inpatients. We investigated the participation of hospitals at different levels of care in Rhineland-Palatinate in the management of the COVID-19 pandemic. Nine pandemic waves were documented during the pandemic and exemplary data on the respective pandemic peaks were evaluated. Adistinction was made between the burden on hospitals at different levels of care: primary care hospitals, standard care hospitals, specialty hospitals, and maximal care hospitals. Analysis of the data showed that all hospital types participated equally in the care of SARS-CoV-2patients. The requirement of the Ministry of Health of Rhineland-Palatinate to provide at least 20% of the available capacity was met by all levels of care and there were no disparities between hospitals of different levels of care in the management of the pandemic.Hospitals at all levels of care participated equally in the care of SARS-CoV‑2 inpatients and thus contributed significantly to the management of the pandemic in Rhineland-Palatinate.

Completion rates of bundle treatment of among patients with sepsis shock in intensive care departments of hospitals in Jiangsu Province from 2016 to 2020 years

Current clinical approaches for septic shock increasingly incorporate bundle treatment, a multi-component approach that uses a collection of tests and agents to assist in the identification and treatment of infection. The present study analyzed completion rates of 3 h and 6 h bundle treatment among patients with septic shock in intensive care units (ICUs) of hospitals in Jiangsu Province from 2016 to 2020, using data from the Jiangsu Provincial Intensive Care Medical Quality Control Center. Current approaches and factors affecting treatment completion were assessed.The completion rates of 3 h and 6 h bundle treatment in ICUs of all medical units in Jiangsu Province and in ICUs of hospitals of different levels were recorded. Analyses show that the completion rate of 3 h and 6 h bundle treatment for patients with septic shock in ICUs in Jiangsu Province increased year by year from 2016 to 2020.The completion rate of 3 h bundle treatment increased from 69.82% (3 604/5 162) to 82.47% (8 915/10 775) (all P<0.001). The completion rate of 6 h bundle treatment increased from 62.69% (3 236/5 162) to 72.54% (7 816/10 775) (all P<0.001). In addition, year by year, the completion rate of 3 h bundle treatment in ICUs in tertiary hospitals increased, from 69.80% (3 596/5 152) to 82.23% (7 375/8 969), while the completion rate of 6 h bundle treatment increased from 62.69% (3 230/5 152) to 72.18% (6 474/8 969) (all P<0.001). Completion rates in secondary hospitals also increased year by year, from 80.00% (8/10) to 85.27% (1 540/1 806) for 3 h treatment and from 60.00% (6/10) to 74.31% (1 342/1 806) (all P<0.001) for 6 h treatment. Completion rates for 3 h treatment in first-tier cities (83.99% (2 099/2 499)) and second-tier cities (84.68% (3 952/4 667)) was higher than in third-tier cities (79.36% (2 864/3 609)). The completion rate of 6 h bundle treatment gradually decreased in first-line (77.19% (1 929/2 499)), second-line (74.37% (3 471/4 667)), and third-line (66.94% (2 416/3 609)) cities (all P<0.001). The data collectively show that from 2016 to 2020, the completion rate of bundle treatment in septic shock patients in ICUs in Jiangsu Province improved significantly.

Factors Affecting Self-Harm- or Violence-Related Urgent Psychiatric Consultation During the COVID-19 Pandemic in Taiwan.

People's health-care-seeking behaviors considerably changed during the COVID-19 pandemic. This study evaluated the changes in self-harm- and violence-related urgent psychiatric consultation (UPC) in the emergency department (ED) during different stages of the pandemic and at different levels of hospitals. We recruited patients who received UPC during the baseline (2019), peak (2020), and slack (2021) periods of the same time window (calendar weeks 4-18) during the COVID-19 pandemic. Demographic data such as age, sex, and referral type (by the police/emergency medical system) were also recorded. We found female gender and younger age associated with higher risk of self-harm-related UPCs, whereas patients visiting regional hospitals, male patients, and patients referred by the policy/emergency medical system, had a higher risk of violence-related UPCs. After adjustment, the different pandemic stages were not significantly associated with self-harm- or violence-related UPCs. Patient's demographic data, but not the pandemic itself, may be responsible for the changes in self-harm- and violence-related UPCs during the pandemic.

Description of the medical services provided to children in Shanghai: a cross-sectional study of the characteristics and disparities of hospitals of different levels and types.

The development of the pediatric care system is uneven in China. Limited research has been conducted on pediatric care in Shanghai, which is a well-developed region in China, in which the National Children's Medical Centers are located. In November 2021, under the commission of the Shanghai Center for Medical Quality Control, a city-wide questionnaire designed to examine the provision of medical services to children in Shanghai in 2020 was conducted at 86 hospitals providing pediatric care. The overall characteristics and disparities between the general hospitals and children's hospitals and suggestions for future developments were explored. In 2020, there were 86 hospitals providing pediatric care, covering all 16 municipal districts of Shanghai, with an average distribution of 1.4 hospitals per 100 km2. The hospitals were mainly public (94.2%) and general (96.5%) hospitals. With a response rate of 90.7%, the questionnaire results revealed that there were 2,683 in-service pediatricians in Shanghai, with an average of 1.1 pediatrician per 1,000 children aged 0-14 years in Shanghai. The pediatricians were mainly women (71.8%), aged 40 years or younger (60.6%), who held a bachelor's degree or higher (99.5%). The total number of pediatric outpatient and emergency visits was approximately 8 million, with an average of 2,973 visits per pediatrician in 2020. There were >370,000 visits to fever clinics. The number of pediatric inpatient visits exceeded 160,000, with an average hospital stay length of 5.8 days. The uneven development between the children's hospitals and general hospitals represents a major challenge facing Shanghai's pediatric care system, and the close links between the 2 types of hospitals need to be further strengthened. Shanghai provides an overall superior medical service to children in China. The close link between the children's hospitals and general hospitals should be further strengthened to optimize the distribution of high-quality resources and greatly improve the overall provision of pediatric medical services.

Measuring the efficiency of public hospitals: A multistage data envelopment analysis in Fujian Province, China.

The present study aimed to evaluate the operational efficiency of public hospitals in Fujian Province and the factors responsible for the inefficiency of these hospitals and provide relevant suggestions for health policymakers in allocating service resources. In the first stage of the research, the variables affecting the efficiency of hospitals were extracted by qualitative and quantitative methods, including literature optimization, gray related analysis and gray clustering evaluation. In the second stage, the data envelopment analysis (DEA) method was used to evaluate the operational efficiency of 49 hospitals of different levels and types selected by sampling in 2020. Finally, a Tobit regression model with introduced institutional factors and background factors was established to study the main influencing factors of hospital inefficiency. In the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the average comprehensive TE, PTE, and SE of 49 sample hospitals was 0.802, 0.888, and 0.902, respectively. 22.45% of these hospitals met the effective criteria, i.e., the overall effective rate was 22.45%. The low SE value of the hospital was the main reason hindering the improvement of the comprehensive efficiency value. The overall effective rate of secondary public hospitals (30.77%) was higher than that of tertiary public hospitals (19.44%), and the overall effective rate of public specialized hospitals (30%) was higher than that of general public hospitals (18.92%). Based on the third stage results, the bed occupancy rate (BOR) and the proportion of beds (POB) were major factors affecting the operation efficiency of grade III hospitals (p < 0.01). However, the operating efficiency of grade II hospitals was significantly affected by POB and regional per capita GDP(GDPPC) (p < 0.05). Moreover, the impact of BOR and GDPPC was positive, and POB was negatively correlated with hospital operation efficiency. The study results indicated that the overall operation efficiency of public hospitals in Fujian Province is low. This study revealed that intervention should be strengthened from a policy and management perspective to improve the operation efficiency of public hospitals.

[Diagnosis and treatment of pediatric septic shock in pediatric intensive care units from hospitals of different levels].

Objective: To investigate the differences in clinical characteristics, diagnosis, and treatment of pediatric septic shock in pediatric intensive care unit (PICU) among hospitals of different levels. Methods: This retrospective study enrolled 368 children with septic shock treated in the PICU of Beijing Children's Hospital, Henan Children's Hospital, and Baoding Children's Hospital from January 2018 to December 2021. Their clinical data were collected, including the general information, location of onset (community or hospital-acquired), severity, pathogen positivity, consistence of guideline (the rate of standard attainment at 6 h after resuscitation and the rate of anti-infective drug administration within 1 h after diagnosis), treatment, and in-hospital mortality. The 3 hospitals were national, provincial, and municipal, respectively. Furthermore, the patients were divided into the tumor group and the non-tumor group, and into the in-hospital referral group and the outpatient or emergency admission group. Chi-square test and Mann-Whitney U test were used to analyze the data. Results: The 368 patients aged 32 (11, 98) months, of whom 223 were males and 145 females. There were 215, 107, and 46 patients with septic shock, with males of 141, 51, and 31 cases, from the national, provincial, and municipal hospitals, respectively. The difference in pediatric risk of mortality Ⅲ (PRISM Ⅲ) scores among the national,provincial and municipal group was statistically significant (26(19, 32) vs.19(12, 26) vs. 12(6, 19), Z=60.25,P<0.001). The difference in community acquired septic shock among the national,provincial and municipal group was statistically significant (31.6%(68/215) vs. 84.1%(90/107) vs. 91.3%(42/46), χ2=108.26,P<0.001). There were no significant differences in compliance with guidelines among the 3 groups (P>0.05). The main bacteria detected in the national group were Klebsiella pneumoniae (15.4% (12/78)) and Staphylococcus aureus (15.4% (12/78)); in the provincial group were Staphylococcus aureus (19.0% (12/63)) and Pseudomonas aeruginosa (12.7% (8/63)), and in the municipal group were Streptococcus pneumoniae (40.0% (10/25)) and Enteric bacilli (16.0% (4/25)). The difference in the proportion of virus and the proportion of 3 or more initial antimicrobials used among the national,provincial and municipal group was statistically significant (27.7% (43/155) vs. 14.9% (13/87) vs. 9.1% (3/33), 22.8%(49/215) vs. 11.2%(12/107) vs. 6.5%(3/46), χ2=8.82, 10.99, both P<0.05). There was no difference in the in-hospital mortality among the 3 groups (P>0.05). Regarding the subgroups of tumor and non-tumor, the national group had higher PRISM Ⅲ (31(24, 38) vs. 22 (21, 28) vs.16 (9, 22), 24 (18, 30) vs. 17(8, 24) vs. 10 (5, 16), Z=30.34, 10.45, both P<0.001), and it was the same for the subgroups of in-hospital referral and out-patient or emergency admission (29 (21, 39) vs. 23 (17, 30) vs. 15 (10, 29), 23 (17, 29) vs. 18 (10, 24) vs. 11 (5, 16), Z=20.33, 14.25, both P<0.001) as compared to the provincial and municipal group. There was no significant difference in the in-hospital mortality among the 2 pairs of subgroups (all P>0.05). Conclusion: There are differences in the severity, location of onset, pathogen composition, and initial antibiotics of pediatric septic shock in children's hospitals of different levels, but no differences in compliance with guidelines and in-hospital survival rate.

A 9-year analysis of medical malpractice litigations in coronary artery bypass grafting in China

BackgroundThe coronary artery bypass grafting (CABG) is one of the high-risk litigated medical specialties. Further elucidating the causes behind these malpractice claims can help physicians avoid patient injury. This study analyzed CABG litigations occurred in different level hospitals to outline the basic characteristics, as well as present a analysis on the medical malpractice that result in lawsuits.MethodsThis study utilized the “China Judgments Online” database to compile litigations from 2012 to 2021 across China. 109 cases related to the CABG were included in the study, and were analyzed for demographic, patient outcomes and verdict characteristics in different levels of hospitals.ResultsThe median age of plaintiff patient was 62 years, the median length of stay was 25 days, and the median responsibility ratio of the litigation cases was 30%. The average proportion of responsibility of national, provincial and municipal hospitals were 29.6%, 28.4% and 39.5% respectively, and the median days after surgery to death of that were 15, 9 and 5 separately. The top 5 postoperative complications in dispute cases were: low cardiac output syndrome, postoperative hemorrhage, non-surgical site infections, surgical site infections and arrhythmia.ConclusionsThe diagnosis and treatment capabilities of coronary artery bypass grafting in different levels of hospitals in China were inconsistent, and the treatment capabilities in prefecture-level hospitals were lower than that in national hospitals. The procedural error, failure to properly monitor the patient and diagnostic errors were common in CABG litigations. Postoperative complications related to surgical injuries and insufficient basic postoperative management lead to a higher responsibility proportion.

Design mechanism to coordinate a hierarchical healthcare system: Patient subsidy vs. capacity investment

Motivated by the problems of imbalance between the supply of and demand for the different levels of hospitals in a hierarchical healthcare system, we propose two contract mechanisms: patient subsidy and capacity investment. Under the patient subsidy scheme, each patient who chooses the primary hospital receives a subsidy from the funder; whereas, under the capacity investment scheme, the primary hospital itself receives investment compensation for expanding service capacity. By employing a game-theoretic queueing model, we determine the optimal decisions (i.e., the patient arrival rate at each hospital, the funder subsidy rate, the primary hospital's capacity allocation rate, and the funder's compensation rate) and characterize the equilibrium outcomes (i.e., social welfare, operating profit, patient utility, and waiting time) for both contract mechanisms. We find that the funder's budget and the size of the patient population play a critical role in scheme performance. The funder must secure a sufficient budget to ensure the effectiveness of either scheme. When the healthcare market is small, the patient subsidy scheme is effective in mitigating the issue of an imbalanced hierarchical system; however, when the market is large and growing, the capacity investment scheme effectively encourages capacity expansion to accommodate the growing demand. Therefore, it is suggested that the funder makes policy decisions based on both the existing and anticipated healthcare system (i.e., market size and development trends), the root issues affecting the system hierarchy, and the associated costs. Additionally, we find that hospital profitability conflicts with total social welfare under some circumstances, and that the funder must therefore strive to align the interests of hospitals with society in order to ensure a successful implementation of the contract scheme.