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.

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.

Background Hand hygiene (HH) is a cost-effective measure to reduce healthcare-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among healthcare 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 healthcare 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 I 2 statistics and a random-effects model was used to contrast between different occupations, the WHO five-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 2377 healthcare 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 five-moments, the healthcare providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%–94%), while before contact with patients healthcare 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% vs openly and secretly observation: 91%; 95% CI: 90%–91%). Conclusions During the COVID-19 pandemic, the compliance of healthcare 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.

Background Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood. Aim To identify the super-factors causing COVID-19 infection in medical staff in China. Methods A cross-sectional study was conducted between January 1 st and February 30 th , 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors. Findings A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes. Conclusion High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working.

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.

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.

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.

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.