National Healthcare Improvement Initiative Research Articles

Pharmaceutical care in Chinese public tertiary hospitals: findings from the 4th National Healthcare Improvement Initiative Survey

BackgroundPharmaceutical care has been playing an increasingly critical role in Chinese hospitals. However, evidence about the most recent development of pharmaceutical care in China is limited. This study analyzed the current situation of pharmaceutical care and the capacities of pharmacists in Chinese public tertiary hospitals.MethodsAll on-duty pharmacists of 143 public tertiary hospitals responded to the Likert-5 pre-set online questionnaire about their pharmaceutical care capacities in eight aspects, and their respective hospitals valued pharmaceutical care in clinical practice from March 18 to 31, 2019. This study measured the appraisals of the responding pharmacists as positive (“strongly agree” and “agree”) or negative (“neither agree nor disagree,” “strongly disagree,” and “disagree”) results. The study performed a descriptive analysis of the responding pharmacists and unconditional multivariate binary logistic regression analysis to predict the influencing factors of the pharmacists’ appraisals of pharmaceutical care. The dependent variable was transformed into binary categories and assigned 1 = positive response and 0 = negative response. The independent variables included the identifications of sample hospitals and the characteristics of the responding pharmacists.ResultsThe survey retrieved 10 815 valid responded questionnaires. 74.5%, 67.5%, and 65.0% of the responding pharmacists made a positive self-appraisal of their abilities of communication with patients and doctors, reviewing prescriptions, and communication with particular patients, respectively. 65.5% had a positive appraisal of their respective hospitals to conduct active monitoring of the clinical use of new medicines, and 68.9% admitted that their respective hospitals valued the clinical pharmaceutical care. The doctor’s degree and senior academic rank of the responding pharmacists, as well as maternal and child hospitals, were predictors of higher appraisals of the responding pharmacists about their pharmaceutical care capacities, and their respective hospitals valued pharmaceutical care (all ORs > 1.5, P < 0.05).ConclusionsThe study suggested that there is a need to strengthen the pharmacy education, training, and staffing of pharmacists with improved professional skills to offer value-added specialized pharmaceutical care in Chinese public hospitals. Patient-centered and inter-disciplinary interactions in medical practice should be promoted. There is also a need for public hospitals to provide a platform for the achievement of the professional values of high-quality pharmacists at different carrier development stages.

Major findings from the 4th Evaluation of the National Healthcare Improvement Initiative

Objective To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction. Key words: Healthcare Improvement Initiative; Third party evaluation; Hospital Survey; Doctor-patient satisfaction

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016–2018)

ObjectivesChina launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective.DesignThis...

Analysis of influencing factors of medical staffs′ perceptions on doctor-patient relationship

Objective To understand the current situation of doctors and nurses perceptions on doctor-patient relationship and its main influencing factors, and to make recommendations for further healthcare improvement. Methods Based on the survey results of the third-party evaluation of the National Healthcare Improvement Initiative of 136 public tertiary hospitals, we analyzed the doctors′ and nurses′ perceptions on doctor-patient relationship and the influencing factors. SAS 9.4 software was used to conduct variance test of doctors′ and nurses′ basic information and multivariate logistic regression analysis of the influencing factors of doctors′ and nurses′ perceptions on doctor-patient relationship. Results The recognition of doctors and nurses on the statement ofdoctor-patient relationship has been getting better, their career identity and hoping children to study medicine varied significantly (P 1, P 1, P<0.05). Conclusions It is imperative to protect rights of doctors and nurses by enforcing relevant laws and regulations, and improving existing medical dispute handling mechanism. Other measures to this end include higher pay for medical workers equivalent to their value and career identity; media guidance by the government, which will all help create a better medical environment and doctor-patient relationship. Key words: Medical staff; Doctor-patient relationship; Influencing factors; Regression analysis

Third-party evaluation of the National Healthcare Improvement Initiative (2nd Round)

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017. The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation. The total number of respondents was 94 218, including 19 773 doctors, 24 315 nurses, 29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals. The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side. The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%. Further improvement is expected. Hospital staff have been actively involved in this Initiative, but they are not satisfied with their working environments and compensations. Key words: Healthcare Improvement Initiative; Outpatients; Inpatients; Third Party Evaluation; National

Application of two-step clustering analysis on inpatient satisfaction analysis

Objective To analyze the differences and influencing factors of inpatient satisfaction on hospitals of different types in different regions two years following implementation of the National Healthcare Improvement Initiative. Methods Data of hospitals and inpatient satisfaction survey results were collected from the a third-party evaluation of the National Healthcare Improvement Initiative, and analyzed in a two-step clustering model. This effort aims at learning the subjective feelings of inpatients and impacts of the objective indicators of medical resources allocation on inpatient satisfaction. The analysis helps identify indicators to be included into the clustering model and their correlation with such satisfaction. Results The two-step clustering rounded hospitals into four categories based on the inpatient overall satisfaction. Gaps were found among different categories of hospitals in terms of types of hospitals, location, affiliation and healthcare resources allocation. The inpatient overall satisfaction varied with these indictors. Among the category with the highest inpatient overall satisfaction, 100% were general hospitals, most of which in eastern area (52.38%), and local hospitals (50.00%). Hospitals in this category feature larger scales and stronger medical techniques. The category with the lowest inpatient overall satisfaction were mostly hospitals located in western regions (65.52%), maternal and child hospitals (41.38%) and local hospitals (89.65%). Most of these hospitals were large in scale, but their medical techniques and resources fell behind their eastern counterparts. The strongest correlation with inpatient overall satisfaction was medical behavior (r=0.95), while the weakest was the medical resources allocation (r<0.30). Conclusions There are gaps of inpatient overall satisfactions among different types of hospitals located in different regions. Patients′ subjective perceptions and medical resources allocation affected their overall satisfactions. The non-medical services were important factors towards patient satisfaction. Key words: Inpatients; Patient satisfaction; Two-step clustering analysis; Healthcare improvement

Status and influencing factor analysis of the perception of outpatients pertaining to doctor-patient relationship

Objective To learn the current situation and influencing factors of outpatients′ perceptions of doctor-patient relationship, and to generate evidence for effective improvement of outpatients′ perceptions of doctor-patient relationship. Methods Based on the results of the third party evaluation of the National Healthcare Improvement Initiative (2016-2017) in 136 hospitals, we analyzed the outpatients′ perceptions of doctor-patient relationship and its influencing factors. Univariate analysis of the outpatients′ perceptions of doctor-patient relationship (Chi-square test and Wilcoxon rank sum test), and binary logistic regression were conducted to analyze the influencing factors of the outpatients′ perceptions of doctor-patient relationship. Results A total of 29 105 out-patients were included in this study. The average outpatient perception score of doctor-patient relationship was 3.88±0.99, and the median was 4.00. The perception score of outpatients pertaining to doctor-patient relationship was the highest in the eastern regions and lowest in the western regions. That of outpatients from general hospitals was highest than that of those in maternal and child hospitals and traditional Chinese medicine hospitals. Patients′ waiting time for consultation, having a fixed physician or general practitioner before visiting, contracting with a community doctor or not, the overall satisfaction, and the household income and insurance coverage were all the influencing factors of the outpatients′ perceptions of doctor-patient relationship (P<0.05). Conclusions There is still a long way to go before the patients can agree with the perception of a better doctor-patient relationship. The critical points for improvement include reducing waiting time for consultation, allocation of more medical resources to the western regions, improving humane care to patients and raising outpatients′ overall satisfactions, especially in the departments of obstetrics and gynecology, and pediatrics. Key words: Outpatients; Doctor-patient relationship; Cognition; Influencing factors; Regression analysis

Multivariate analysis of influencing factors of outpatients′ satisfaction in hospitals of different types

Objective To explore the influencing factors of inpatients′ satisfaction in different types of hospitals from the perspective of demand and supply sides, and to generate evidence for further healthcare improvement in different types of hospitals. Methods Based on the inpatient satisfaction survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals, the discharged inpatients were divided in four groups according to the hospital types as general, traditional Chinese medicine (TCM), maternal and child (MCH) and specialty hospitals. SPSS 22.0 and SAS 9.4 softwares were used to conduct the Pearson chi-square test, variance analysis, Bonferroni test for univariate analysis, and binary multivariate logistic regression analysis, to explore the influencing factors of inpatients′ satisfaction in different types of hospitals. Results The social and demographic characteristics were adjusted. Reasonable hospitalization expenditure was the most common influencing factor of inpatients′ satisfaction in general hospitals, TCM hospitals and MCH hospitals (P<0.01, OR=2.89, 2.53, 2.98). Quiet hospitalization environment was the most significant influencing factor of inpatients satisfaction in specialty hospitals (P<0.01, OR=2.32). Time-phased appointment for tests and examinations was another significant influencing factor of inpatients satisfaction of MCH hospitals(P<0.01, OR=2.25)and TCM hospitals(P<0.01, OR=1.91). Convenient admission was another influencing factor of inpatients satisfaction in specialty hospitals (P<0.01, OR=2.21). Conclusions In the next stage of healthcare improvement, different types of hospitals should take targeted actions. Specialty hospitals should control the visiting schedule and strengthen sound blocking facilities in the ward, in order to keep a quiet environment for inpatients, and further simplify the admission procedures. MCH and TCM hospitals should further promote the precise appointment system for tests and examinations. Key words: Inpatients; Patient satisfaction; Questionnaires; Regression analysis; Influencing factor

Multivariate analysis of influencing factors of inpatients′ perception of doctor-patient relationship

Objective To understand the current situation of inpatients′ perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement. Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals, we analyzed the inpatients′ perceptions of doctor-patient relationship. SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test, and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′ perceptions of doctor-patient relationship. Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34±0.84, and the median was 5.00. The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents (P<0.05), that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P<0.05). The overall satisfaction of inpatients during hospitalization (P<0.01, OR=2.73) and doctors′ satisfaction to have enough communication time with patients (P<0.01, OR=1.84) were the most significant protection factors to inpatients′ perceptions of doctor-patient relationship. The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor. Inpatients who had fixed physicians or general practitioners before visiting (P<0.01, OR=1.31) was another statistically significant positive influencing factor of inpatients′ perceptions of doctor-patient relationship. Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′ satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition, measures like integration of family doctor system and medical alliance system, as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship. Key words: Inpatients; Doctor-patient relationship; Cognition; Influencing factors; Regression analysis

Impacts of the referral system on outpatient satisfaction: an analysis of propensity score analysis

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system. Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment (2016-2017), the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred. Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower (P<0.01, 95%CI=-0.17, -0.06). The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03, 95%CI=-0.11, -0.01). Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction. To further improve the referral system and to raise patient satisfaction, there is a need to take following actions, to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system, to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system. In addition, it is critical to further regulate and optimize the referral procedures, so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy. Finally, it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system. Key words: Patient transfer; Hierarchical medical system; Propensity matching method; Outpatients; Satisfaction

Survey of providers' awareness and implementation of the National Healthcare Improvement Initiative in China

Objective To gauge into provider's knowledge of and participation in the China Healthcare Improvement Initiative(the Initiative)and into factors for improvement quality of care. Methods The questionnaire was designed based on such dimensions as awareness of the Initiative, procedures and environment, patient centering and work efficiency.Doctors and nurses were randomly sampled from 136 tertiary hospitals in China's 31 provinces, and were surveyed with their awareness and implementation of the Initiative by means of descriptive and non-parameter test methods. Results 85.4% of the doctors and nurses surveyed knew about the Initiative being launched at their hospital.Over 97% of the subjects said they provided care, as evidenced in strict observation of the checkup regulations and the hand-washing regulations before medical service; protection of patient's privacy, and patient's comforting.66.4% of them said to spend sufficient time in communicating with patients, as evidenced in 33.4% of the doctors communicating 10-20 minutes and 28.9% over 20 minutes for an average clinical encounter. Conclusions The Initiative is warmly embraced by medical institutions and providers at large, and patient-centered service is well implemented, yet further improvement is needed in such aspects as effective communication with patients. Key words: Healthcare Improvement Initiative; Medical workers; Awareness; Implementation