How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application

Abstract

Background Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. Methods A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure–process–outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. Results Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. Conclusions Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Elevated pretreatment serum apolipoprotein E level associated with poor prognosis of patients with COVID‐19 during the omicron BA.5 and BF.7 wave

“…A study has unveiled that the interaction between ApoE and ACE2 is responsible for SARS-CoV-2 infection, leading to heightened susceptibility and severity of COVID-19 in carriers of the ApoE ε4 allele. 25 In a murine model of SARS-CoV-2 infection, ApoE genotyping can predict the poor prognosis of COVID-19, with mice carrying the ApoE4 gene exhibiting significantly reduced survival rates. 26,27 This study found that higher ApoE levels in omicron patients were associated with a higher risk for mortality and a lower OS rate.…”

“…In our study, we observed that patients exhibiting elevated levels of ApoE displayed lower absolute counts of CD3 and CD8 lymphocytes. A study has unveiled that the interaction between ApoE and ACE2 is responsible for SARS‐CoV‐2 infection, leading to heightened susceptibility and severity of COVID‐19 in carriers of the ApoE ε4 allele 25 . In a murine model of SARS‐CoV‐2 infection, ApoE genotyping can predict the poor prognosis of COVID‐19, with mice carrying the ApoE4 gene exhibiting significantly reduced survival rates 26,27 .…”

The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data

“…The initial indicator list was consisted of major domains of national Healthy China Initiative as well as specific indicators available under the context of the target region. Afterwards, 7-rounds of focus group discussions were adopted to determine which indicators should be added into or excluded from the initial indicator list [41,45]. In total 7 experts from official departments, academe and universities who were familiar with the project very well were invited to join the group discussions and review the indicators based on local realities, and suggestions were also collected from 18 practitioners from provincial and municipal working unit, which was more practical and effective when a novel framework forming.…”

“…The Analysis Hierarchical Process (AHP), which was formally proposed by Thomas L. Saaty, was adopted for the weights calculation. The method has been proved to be a reliable tool to facilitate systematic and logical decision-making processes, and widely adopted in solving social, industrial and healthy problems via constructing a judgment matrix for analyzing and determining the weights of each criterion [45,56,57]. In this research, the 8 experts who had participated in the Delphi method were invited to further rate the weights of indicators in the AHP survey to ensure the effectiveness and the consistency of the consultation as well as the reliability of the results.…”