Financial toxicity in female patients with breast cancer: a national cross-sectional study in China.

PURPOSE: To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients' coping strategies. METHODS: The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0-IV breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used. RESULTS: The median age of patients was 48 years (range: 26-84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (interquartile range: 15-26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage IV cancer, and a history of targeted therapy were associated with higher financial toxicity (all P < 0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, and failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies. CONCLUSIONS: Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help oncologists and policy-makers identify at-risk patients and develop targeted interventions.

Analysis of the Cost and Case-mix of Post-acute Stroke Patients in China Using Quantile Regression and the Decision-tree Models.

Purpose: Post-acute care is fast developing in China, yet a payment system for post-acute care has not been established. As stroke is the leading cause of mortality and disability in China, patients constitute a large share of post-acute-care patients among all hospitalized patients. This study was to identify the cost determinants and establish a case-mix classification of the post-acute care system for stroke patients in China. Patients and Methods: A total of 5401 post-acute stroke patients in seven hospitals of Jinhua City from January 2018 to December 2020 were selected. Demographic characteristics, medical status, functional measures (eg, the Barthel Index, Mini-Mental State Examination, Gugging Swallowing Screen, Hamilton Depression Scale), and cost data were extracted. Generalized linear model (GLM) and quantile regression (QR) were conducted to determine the predictors of cost, and a case-mix classification model was established using the decision-tree analysis. Results: The GLM regression revealed that gender, tracheostomy, complication or comorbidity (CC), activities of daily living (ADL), and cognitive impairment were the main variables significantly affecting the hospitalization expenses of post-acute stroke patients. The QR model showed that the gender, tracheostomy and CC factors had a more significant impact on per diem costs on the upper quantiles. In contrast, cognitive impairment had a more substantial effect on the lower quantiles, and ADL significantly impacted the central quantile. Using tracheostomy, CC, and ADL as node variables of the regression tree, 12 classes were generated. The case-mix classification performed reliably and robustly, as measured by the reduction in the variation statistic (RIV=0.46) and class-specific coefficients of variation (CV less than 1.0; range: 0.18-0.81). Conclusion: QR has strengths in comprehensively identifying cost predictors across cost groups. Tracheostomy, CC, and ADL significantly can predict the expenses of post-acute care for stroke patients. The established case-mix classification system can inform the future payment policy of post-acute care in China.

Influence of patient and hospital characteristics on inpatient satisfaction in China's tertiary hospitals: A cross-sectional study.

BACKGROUND: Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health-care reform in China. This paper aimed to explore patient- and hospital-level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient-oriented health-care system. METHODS: The paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction. RESULTS: Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse-to-bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. CONCLUSION: Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well-functioning health-care delivery system in order to better serve patients in China.

Job satisfaction and associated factors among psychiatric nurses in tertiary psychiatric hospitals: Results from a nationwide cross-sectional study.

AIMS: To investigate the job satisfaction among psychiatric nurses in China and to explore its associated factors. DESIGN: A cross-sectional survey among a nationwide sample from 32 tertiary psychiatric hospitals in 29 provincial capitals in China. METHODS: Nurses (N = 9.907) were targeted for this survey in December 2017. In all, 8,493 responded (response rate = 85.7%) and 7,881 (79.5%) were included in the analysis. An online questionnaire was used to collect demographics and factors related to the work environment. The short version of the Minnesota Satisfaction Questionnaire was used to assess job satisfaction. Multilevel regression was used to examine the association between job satisfaction and these factors. RESULTS: The mean job satisfaction score was 73.7. The multiple regression analysis indicated that self-rated health, monthly income, medical liability insurance coverage, perceived respect from patients, social recognition, nurse-physician collaboration, and trust were significantly associated with higher job satisfaction scores, while age, work hours, and directly experiencing patient-initiated violence were negatively associated with job satisfaction (p < .05). CONCLUSION: Overall, Chinese psychiatric nurses are closer to satisfied than neutral and some demographics and factors related to stressful work environments were associated with nurses' job satisfaction scores. IMPACT: This study examined factors associated with the job satisfaction of Chinese psychiatric nurses in a nationwide sample and indicated that to improve nurses' job satisfaction, the government and hospital administrators could consider ways to promote nurses' personal health and to modify the stressful work environments, such as improving income, reducing work hours, promoting the psychiatric nursing specialty in ways that increase the public's respect for it, increasing awareness of medical liability insurance coverage, and protecting nurses from patients' violence.

Outpatient Satisfaction with Tertiary Hospitals in China: The Role of Sociodemographic Characteristics.

China's increasing attention to patient satisfaction evaluation is part of an international trend of patient-centered healthcare. Patient sociodemographic characteristics are important intrinsic factors that will influence satisfaction. This paper aims to better understand how sociodemographic factors affect Chinese patient satisfaction with tertiary outpatient services using data from the 2017 China National Patient Survey. A total of 28,760 outpatient survey responses were analyzed, spanning 136 tertiary hospitals across 31 provinces. Multilevel logistic regression with fixed hospital effects was used to examine the association of patient satisfaction across multiple healthcare domains with sociodemographic factors. Results show that patients who were of a migrant population, of highest income, most educated, and who had medical aid insurance reported the lowest levels of overall satisfaction. Specifically, increasing age was correlated with decreased satisfaction in process management and affordability domains, while high-income and high-education outpatients reported lower satisfaction scores in the hospital environment domain. Furthermore, migrant patients experienced lower satisfaction across several domains. These intricate findings suggest that hospitals should tailor their services and evaluation metrics to specific patient demographics, and that the government should adopt policies that reduce disparities in healthcare access and affordability to ultimately improve the satisfaction of vulnerable groups.

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

OBJECTIVES: China 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. DESIGN: This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China. SETTING: A total of 117 tertiary hospitals in mainland China. PARTICIPANTS: 48 422 responses from outpatients and 35 957 responses from inpatients were included in this study. PRIMARY OUTCOME MEASURE: The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating. RESULTS: More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016-2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings. CONCLUSIONS: The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

[Safety value of contaminant in water pollution accident based on human health risk].

The acute human health risk assessment of contaminant in water pollution accident is a new study field of environmental sciences. This study established a model for calculating acute safety value of contaminant in water pollutant. The acute safety value of contaminant in mainly water pollution during 2000-2010 was calculated by this model. The safety value of sodium cyanide, cadmium, formaldehyde, ammonia, toluene, nitrobenzene, microcystin-LR were 0.1, 0.6, 8, 20, 6, 0.07, 0.004 mg x L(-1), respectively. The differences of safety value calculate methods between acute and chronic exposure were compared from the following aspects, the toxicology exposure end-point, allocation of intake, exposure sensitive subpopulation.

The Contribution of Population Health and Demographic Change to Economic Growth in China and India.

We find that a cross-country model of economic growth successfully tracks the growth takeoffs in China and India. The major drivers of the predicted takeoffs are improved health, increased openness to trade, and a rising labor force-to-population ratio due to fertility decline. We also explore the effect of the reallocation of labor from low-productivity agriculture to the higher-productivity industry and service sectors. Including the money value of longevity improvements in a measure of full income reduces the gap between the magnitude of China's takeoff relative to India's due to the relative stagnation in life expectancy in China since 1980.