The formation mechanism of primary health care team effectiveness : a qualitative comparative analysis research.

BACKGROUND: Team-based care is an essential part of primary health care (PHC), and its team service delivery process is a systematic one involving multiple and complex influences. Research on the formation mechanism can help improve the effectiveness of primary health care teams (PHCTs). METHODS: First, based on the Donabedian model, we explored the theoretical framework of a PHC team's effectiveness formation mechanism. Semi-structured interviews were conducted with 23primary health care team members in Hangzhou, Zhejiang Province, China. A total of seven factors were then included as conditional variables using the crisp set qualitative comparative analysis (csQCA) to explore the complex influences between them and the outcome variable through univariate necessity analysis and path configuration analysis. RESULTS: Univariate necessity analysis showed that only "Clear Goals" in the structural dimension were necessary for team effectiveness perception. Six pathways to good primary health care team perception of effectiveness were identified. Two of these paths were more typical. CONCLUSION: "Clear Goals" was the core variable that should be emphasized when exploring the mechanism of PHCT formation. The results suggest that human resources in the management team should be rationally allocated, goal-oriented, and given good attention. Future studies should explore complex combinations of PHCT factors to improve the effectiveness of PHCTs.

Best-Worst Scaling Survey of Inpatients' Preferences in Medical Decision-Making Participation in China.

This study assesses inpatients' preferences for participating in medical decision-making and determines the factors' rankings in order of importance and whether they vary for respondents with different characteristics. Case 1 best-worst scaling (BWS) was used for the study design. Thirteen attributes influencing inpatient medical decision-making participation were identified based on a literature review and interview results. A balanced incomplete block design was used to form choice sets for the BWS questionnaire for a cross-sectional study examining inpatients' preferences for participating in medical decision-making. Based on results from 814 inpatient participants, the three most important factors influencing inpatients' medical decision-making participation were inpatients' trust in physicians, physicians' professional expertise, and physicians' attitudes. The mixed logit model results reflect the significant heterogeneity in respondents' preferences for shared decision-making. To facilitate resource allocation, improve the physician-patient relationship, and encourage patient decision-making participation more actively and effectively, decision-makers should emphasize patients' trust, enhance physicians' ability to diagnose and treat diseases, and improve their attitudes toward providing care and communication from the perspectives of patients, physicians, and the social environment. Further research is needed on the heterogeneity of patients' preferences for participating in medical decision-making and how to improve patient participation.

Behavioral Patterns of Supply and Demand Sides of Health Services for the Elderly in Sustainable Digital Transformation: A Mixed Methods Study.

The aging transformation of digital health services faces issues of how to distinguish influencing factors, redesign services, and effectively promote measures and policies. In this study, in-depth interviews were conducted, and grounded theory applied to open coding, main axis coding, and selective coding to form concepts and categories. Trajectory equifinality modeling clarified the evolution logic of digital transformation. Based on the theory of service ecology, a digital health service aging model was constructed from the "macro-medium-micro" stages and includes governance, service, and technology transformation paths. The macro stage relies on organizational elements to promote the institutionalization of management and guide the transformation of governance for value realization, including the construction of three categories: mechanism, indemnification, and decision-making. The meso stage relies on service elements to promote service design and realize service transformation that is suitable for aging design, including the construction of three categories: organization, resources, and processes. The micro stage relies on technical elements to practice experiencing humanization, including the construction of three categories: target, methods, and evaluation. These results deepen the understanding of the main behaviors and roles of macro-organizational, meso-service, and micro-technical elements in digital transformation practice and have positive significance for health administrative agencies to implement action strategies.

Relationship between obesity indicators and hypertension-diabetes comorbidity among adults: a population study from Central China.

OBJECTIVE: To identify the relationship between obesity indicators and hypertension-diabetes comorbidity (HDC) among adults in central China. DESIGN AND SETTING: A cross-sectional study was conducted from 1 June 2015 to 30 September 2018 in 11 districts of Hubei Province, China. PARTICIPANTS: A total of 29 396 participants aged 18 years or above were enrolled in the study. 2083 subjects with missing data were excluded. Eventually, 25 356 participants were available for the present analysis. MAIN OUTCOME MEASURES: Data were subjected to univariable and multivariable logistic regression to examine the association between obesity indicators (body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR)) and HDC prevalence. Crude odds ratio and adjusted OR (AOR) with associated 95% CI were calculated. RESULTS: Overall, 2.8% of the respondents had HDC. The odds of HDC prevalence increased with the BMI of the participants (18.5≤BMI (kg/m2)≤23.9-1; 24≤BMI (kg/m2)≤26.9-AOR: 5.66, 95% CI: 4.25 to 7.55; BMI (kg/m2)≥27-AOR: 7.96, 95% CI: 5.83 to 10.87). The risk of HDC also increased with the WHtR of participants (WHtR≤P25-1; P25≤WHtR≤P50-AOR: 1.73, 95% CI: 1.10 to 2.71; P50 ≤WHtR≤P75-AOR: 2.51, 95% CI: 1.60 to 3.92; WHtR≥P75-AOR: 3.22, 95% CI: 2.01 to 5.16). Stratified analysis by gender showed that high BMI and WHtR were risk factors of HDC in males and females. However, the odds of HDC prevalence increased only when WHtR≥P75 in males, whereas the probability of HDC increased when WHtR≥ P25 in females. CONCLUSION: High BMI and WHtR can increase the risk of HDC among Chinese adults. Reasonable control of BMI and WHtR may be beneficial in preventing HDC. Females should focus on maintaining an optimal WHtR earlier.

Career Calling as the Mediator and Moderator of Job Demands and Job Resources for Job Satisfaction in Health Workers: A Cross-Sectional Study.

Job satisfaction of health professionals is a key determinant of the quality of health services and even affects the development of the healthcare system. In this study, we sought to explore the mechanism by which job demands, job resources, and career calling affect the job satisfaction of health professionals. Our findings may provide insights for increasing their job satisfaction and improving the quality of health services. We conducted a questionnaire survey of 1,117 health workers in Hangzhou; t-test, Chi-squared analysis, hierarchical linear regression was used to analyze the state of job satisfaction of health personnel and the associated factors; path analysis with the Structural Equation Model was used to explore and verify the effects of job resources, demands, and career calling on job satisfaction, as well as their mechanism. Social support, performance feedback, working conditions, and career calling had significant positive effects on job satisfaction of health professionals, whereas work-family conflict and emotional requirements for work had significant negative effects. Path analysis indicated that job resources, demands, and career calling directly affected job satisfaction; job resources and demands showed indirect effects on job satisfaction with career calling as a mediator. Career calling had a positive moderating effect in the path of "job resources-job satisfaction," and a negative moderating effect in the path of "job demands-job satisfaction." In conclusion, hospital administrators should provide more job resources for health workers and formulate reasonable job demands while paying close attention to work-related pressure. Hospital administrators and health departments need to improve hospital policies and inculcate a sense of belonging and career calling among health professionals. Education and evaluation of career calling need to be accorded more attention so that healthcare workers can perceive a stronger sense of calling and achievement, and hence a higher degree of job satisfaction.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis.

BACKGROUND: Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. AIM: To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. METHODS: The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. FINDINGS: Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). CONCLUSIONS: During the COVID-19 pandemic, the compliance of health care providers' HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for "before contact with patients" should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Impact of Sociodemographic Characteristics, Lifestyle, and Obesity on Coexistence of Diabetes and Hypertension: A Structural Equation Model Analysis amongst Chinese Adults.

BACKGROUND: In general, given the insufficient sample size, considerable literature has been found on single studies of diabetes and hypertension and few studies have been found on the coexistence of diabetes and hypertension (CDH) and its influencing factors with a large range of samples. This study aimed to establish a structural equation model for exploring the direct and indirect relationships amongst sociodemographic characteristics, lifestyle, obesity, and CDH amongst Chinese adults. METHODS: A cross-sectional study was conducted in a representative sample of 25356 adults between June 1, 2015, and September 30, 2018, in Hubei province, China. Confirmatory factor analysis was initially conducted to test the latent variables. A structural equation model was then performed to analyse the association between latent variables and CDH. RESULTS: The total prevalence of CDH was 2.8%. The model paths indicated that sociodemographic characteristics, lifestyle, and obesity were directly associated with CDH, and the effects were 0.187, 0.739, and 0.353, respectively. Sociodemographic characteristics and lifestyle were also indirectly associated with CDH, and the effects were 0.128 and 0.045, respectively. Lifestyle had the strongest effect on CDH (ß = 0.784, P < 0.001), followed by obesity (ß = 0.353, P < 0.001) and sociodemographic characteristics (ß = 0.315, P < 0.001). All paths of the model were significant (P < 0.001). CONCLUSION: CDH was significantly associated with sociodemographic characteristics, lifestyle, and obesity amongst Chinese adults. The dominant predictor of CDH was lifestyle. Targeting these results might develop lifestyle and weight loss intervention to prevent CDH according to the characteristics of the population.

The Impact of China's Zero Markup Drug Policy on Hospitalization Expenses for Inpatients in Tertiary Public Hospitals: Evidence Based on Quantile Difference-in-Difference Models.

OBJECTIVES: The aim of this study was to determine the impact of the Zero Markup drug (ZMD) policy on hospitalization expenses for inpatients in tertiary Chinese hospitals. METHODS: Using the administrative data from hospital electronic health records (EHRs) between 2015 and 2017, we implemented the quantile difference-in-differences (QDID) estimators to evaluate the impact of the ZMD policy on hospitalization expenses while controlling for patient-level and hospital-level characteristics. RESULTS: According to the QDID models, the introduction of ZMD policy significantly induced lower drug costs for all inpatients especially at the 50th (-USD 507.84 (SE = USD 90.91), 75th (-USD 844.77 (SE = USD 149.70), and 90th (-USD 1400.00 (SE = USD 209.97)) percentiles of the overall distributions. However, the total hospitalization, diagnostic, treatment, material and services expenses for inpatients were significantly higher for the treated group than the control group. This tendency was more pronounced for inpatients in tertiary hospitals with lower expenses (in the 10th, 25th and 50th percentiles). CONCLUSION: The implementation of ZMD policy alone may not be enough to change the medical service providers' profit-driven behavior. The targeted supervision of hospital costs by the Chinese health administration department should be strengthened to avoid unreasonable hospital charges.

Development of competency model for family physicians against the background of 'internet plus healthcare' in China: a mixed methods study.

BACKGROUND: Identification of the service competences of family physicians is central to ensuring high-quality primary care and improving patient outcomes. However, little is known about how to assess the family physicians' service competences in primary care settings. It is necessary to develop and validate a general model of core competences of the family physician under the stage of construction of family doctor system and implementation of 'Internet Plus Healthcare' service model in China. METHODS: The literature review, behavioural event interviews, expert consultation and questionnaire survey were performed. The scale's 35 questions were measured by response rate, highest score, lowest score, and average score for each. Delphi method was used to assess content validity, Cronbach's α to estimate reliability, and factor analysis to test structural validity. Respondents were randomly divided into two groups; data for one group were used for exploratory factor analysis (EFA) to explore possible model structure. Confirmatory factor analysis (CFA) was then performed. RESULTS: Effective response rate was 93.56%. Cronbach's α coefficient of the scale was 0.977. Factor analysis showed KMO of 0.988. Bartlett's test showed χ2 of 22 917.515 (df = 630), p < .001. Overall authority grade of expert consultation was 0.80, and Kendall's coefficient of concordance W was 0.194. By EFA, the five-factor model was retained after thorough consideration, and four items with factor loading less than 0.4 were proposed to obtain a five-dimension, 32-item scale. CFA was performed on the new structure, showing high goodness-of-fit test (NFI = 0.98, TLI = 0.91, SRMSR = 0.05, RMSEA = 0.04). Overall Cronbach's α coefficients of the scale and each sub-item were greater than 0.9. CONCLUSIONS: The scale has good reliability, validity, and credibility and can therefore serve as an effective tool for assessment of Chinese family physicians' service competences.

Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three-stage data envelopment analysis of the Shanxi province.

In China, health care resources for expectant mothers and children are still not utilized to full efficiency, with health requirements still not being met. The purpose of this study is to critically examine the efficiency of gynecology and obstetrics hospital (OB/GYN) units in Shanxi province of China, with the overarching objective of exploring methods for improving their efficiency. We employ the three-stage data envelopment analysis (DEA) model to measure the efficiency of 134 OB/GYN units in Shanxi. The results show that the technical efficiency and scale efficiency scores of the sample units were low (0.48 and 0.54, respectively). The efficiency of the OB/GYN units varies by region, city, and county and by type of unit. We conclude that the main reason for the low efficiency of OB/GYN units in Shanxi province lies in the unreasonable scale. The government should, therefore, allocate health resources more reasonably, improving the efficiency of different regions, cities, and counties, as well as different types of OB/GYN units.

Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations.

This study examined urban-rural differences in the association of access to healthcare with self-assessed health and quality of life (QOL) among old adults with chronic diseases (CDs) in China. The data of 5796 older adults (≥60) with self-reported CDs were collected from the Study on Global Ageing and Adult Health in China, including indicators of self-assessed health and QOL and information on access to healthcare. Associations of access to healthcare with self-assessed health and QOL at the 10th, 50th, and 90th conditional quantiles were determined after controlling individual and household factors, showing that urban patients who received healthcare within two weeks gave higher ratings on self-assessed health scores at the 10th and 50th quantiles. In rural areas, one-year and two-week access to healthcare was found to be associated with QOL scores at the 10th and 90th quantiles, respectively. Marginal effects of using needed health service decreased with a growth in QOL and self-assessed health scores in both urban and rural locations despite these effects being significant across the whole distribution. Overall, access to healthcare affects the self-assessed health and QOL of the elderly with CDs in China, especially in patients with poor health, though differently for urban and rural patients. Policy actions targeted at vulnerable and rural populations should give priority to reducing barriers to seeking health services.

Hospital volume and outcomes for inpatients with acute myocardial infarction in Shanxi, China: A cross-sectional study.

In this cross-sectional study, we assessed the relationship between hospital volume and clinical outcomes for inpatients with acute myocardial infarction (AMI) in tertiary A hospitals in Shanxi, China (N = 12 931). In-hospital mortality, length of stay (LOS), and total cost were measured. The crude in-hospital mortality rate was 1.69%. Adjusted in-hospital mortality was significantly lower for medium-volume hospitals (odds ratio (OR) = 0.605, 95% confidence interval (CI) = 0.411-0.900) compared with low-volume hospitals. LOS in medium- and high-volume hospitals were 0.915 (95% CI = 0.880-0.951) and 1.069 (95% CI = 1.041-1.098) days longer than in low-volume hospitals, respectively. The cost of inpatients attending low- and high-volume hospitals (OR = 1.180, 95% CI = 1.140-1.221) was higher than that of medium-volume hospitals (OR = 0.897, 95% CI = 0.868-0.926). These results inform health care policy in countries with strained medical resources.

Does Hospital Competition Harm Inpatient Quality? Empirical Evidence from Shanxi, China.

This study aimed to determine whether hospital competition is associated with improved in-hospital mortality in Shanxi, China. We included a total of 46,959 hospitalizations for acute myocardial infarction (AMI) and 44,063 hospitalizations for pneumonia from 2015 to 2017. Hospital competition was measured as Herfindahl⁻Hirschman Index based on the patient predicted flow approach. Two-level random-intercept logistic models were applied to explore the effects of hospital competition on quality for both AMI and pneumonia diagnoses. Hospital competition exerts negative or negligible effects on inpatient quality of care, and the pattern of competition effects on quality varies by specific diseases. While hospital competition is insignificantly correlated with lower AMI in-hospital mortality (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.77⁻1.11), high hospital competition was, in fact, associated with higher in-hospital mortality for pneumonia patients (OR: 1.99, 95% CI: 1.51⁻2.64). Our study suggests that simply encouraging hospital competition may not provide effective channels to improve inpatient quality of health care in China's current health care system.

Does A Medical Consortium Influence Health Outcomes of Hospitalized Cancer Patients? An Integrated Care Model in Shanxi, China.

OBJECTIVE: To assess the effect of the medical consortium policy on the outcomes of cancer patients admitted to secondary hospitals in Shanxi, China. METHOD: Electronic medical records of lung cancer (n = 8,193), stomach cancer (n = 5,693) and esophagus cancer (n = 2,802) patients hospitalized in secondary hospitals were used. Propensity score matching was used to match each patient enrolled in medical consortium hospitals with a counterpart admitted in non-medical consortium hospitals. Cox proportional hazard models were used to estimate the hazard ratio of patients enrolled different categories of hospitals. RESULTS: The hazards of lung, stomach and esophageal cancer patients admitted in medical consortium hospitals were consistently and significantly lower than those admitted in non-medical consortium hospitals after adjusting for a number of potential confounders. Lower hazard ratios were associated with lung (hazard ratio (HR) = 0.533, p < 0.001), stomach (HR = 0.494, p < 0.001), and esophagus (HR = 0.505, p < 0.001) cancer patients in medical consortium hospitals. CONCLUSION: The medical consortium provides an effective strategy to improve the outcomes of cancer patients in Shanxi, China. The partnerships between top-tier hospitals and grassroots medical services bridge the gap in resources and plays a critical role in the quality of care in China.

Rapid Risk Assessment Report for Schistosomiasis Epidemic in Jianli County Caused by the Sunk "Oriental Star" Cruise Ship.

BACKGROUND: At 9:28 pm on June 1, 2015, the cruise ship "Oriental Star" sank into Yangtze River in Jianli County, with 422 people killed. When the accident occurred, the Chinese government took immediate action and dispatched more than 9000 rescuers. The risk for outbreak of schistosomiasis was increased because of the shipwreck. Obviously it is critical to carry out risk assessment as soon as possible. METHODS: By means of the Delphi method, the situation was analyzed so that the government could fathom the severity of the accident. Then, through matrix and sigma-plotting (3-dimensional graphics) methods, related authorities performed risk assessment after site investigation. RESULTS: The latest news reported that more than 9000 people were involved in the rescue. The affected river was analyzed and mapped using SigmaPlot software, according to which the possibility, harmfulness, and controllability of the accident were determined to be medium (6), medium (6), and poor (7), respectively. CONCLUSION: The site of the accident where the cruise ship sank and rescue operations were carried out is a schistosomiasis epidemic area with high mortality and morbidity. The chance of an outbreak of the schistosomiasis epidemic in Jianli County is quite high. To protect people in this county from the epidemic, relevant logistic services should be arranged and all remains should be cleared up carefully. (Disaster Med Public Health Preparedness. 2018;12:147-153).

Meta-analysis of the diagnostic efficiency of the questionnaires screening for schistosomiasis.

Schistosomiasis is the second widespread tropical disease that affects the health of over 240 million people of 78 countries. Questionnaires have been commonly used to diagnose schistosomiasis, while no meta-analysis of their efficacy had been reported previously. This meta-analysis was conducted to assess their diagnostic accuracy of schistosomiasis. Studies published prior to December 1, 2014, that had used questionnaires as a diagnostic tool were searched in PubMed, Medline, EMBASE, and China National Knowledge Infrastructure (CNKI) database. A total of 32 studies with 72,812 cases were identified for the meta-analysis. The best diagnostic odds ratio (DOR) was obtained from Schistosoma haematobium (67.68, 95 % confidence interval (CI) = 31.48 to 145.54), followed by Schistosoma japonicum (11.74, 95 % CI = 4.59 to 30.05) then Schistosoma mansoni (2.98, 95 % CI = 1.95 to 4.54). Pooled sensitivity and specificity were respectively 0.82, 0.88, and 0.46, and 0.59, 0.86, and 0.81 for S. japonicum, S. haematobium, and S. mansoni. The multivariable subgroup analyses showed that the questionnaires which had been pretested and standardized had better diagnostic performance. The result suggested that questionnaires can be used to diagnose schistosomiasis with moderate sensitivity and specificity and the questionnaires for diagnosing S. haematobium performed best.

[Risk assessment of schistosomiasis transmission on rescue workers involved in "Oriental Star shipwreck event"].

OBJECTIVE: To assess the impact of the "Oriental Star shipwreck event" on the risk of schistosomiasis transmission in Jianli County, Hubei Province, so as to provide the evidence for formulating appropriate measures of schistosomiasis prevention and control. METHODS: Based on the field observation and investigation, the data of the on-the-spot rescue and the historical endemic situation of schistosomiasis in Jianli County were collected and analyzed. Meanwhile, the focus group discussion and risk matrix were conducted to assess the risk of schistosome infection of the rescuers. RESULTS: Over 10 000 rescuers participated in the search operation, including the armed police forces, local people, reservists and so on. The armed police forces were the major components, which accounted for 39%. Jianli country was schistosomiasis endemic area with a high infection level in history, but the endemic situation had been mitigated significantly after years of positive prevention and treatment; the schistosome infection rate of population was 0.44% in 2014 and the Oncomelania hupensis snail area was only 6.6 hm2 around the rescue areas in the upstream and downstream. In addition, the snail density was not high, and no infected snails had been found for 11 years. The risk of schistosome infection was in the medium level. CONCLUSIONS: Though there exists the schistosome infection risk in the water area where the accident happened, the probability of occurrence is not high. In order to prevent the outbreak and endemic of schistosomiasis, the protection measures and health education to the rescuers as well as snail control and monitoring, and early-warning should be strengthened.