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The epidemic of the coronavirus disease 2019 （COVID-19） has presented great challenges to the public health throughout the world. Therefore， it is crucial to foster high-level and multi-disciplinary public health talents to further improve public health. Herein， we summarize the current situation and challenges for public health education and prospect the requirements for training public health talents in China. Colleges and universities bear the responsibility for training public health talents， which is essential for the construction of public health system. In this context， we introduce the education for public health and the Doctor of Public Health （DrPH） program at Fudan university.
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Objective:To explore the influencing factors and pathways of social responsibility of public hospitals, and to provide a reference for public hospitals in China to further improve the social responsibility level.Methods:From 2019 to 2020, 22 tertiary public hospitals in a region were selected as study cases. The social responsibility score was used as the outcome variable, social benefit, appropriateness, quality, and efficiency were used as the conditional variables, and the qualitative comparative analysis was applied to investigate the combination of conditions affecting social responsibility evaluation of public hospitals.Results:The consistency of the social benefit, appropriateness, and quality was less than 0.9 and greater than 0.8, indicating that they were sufficient and non-necessary conditions for high social responsibility of public hospitals. The consistency of efficiency was 0.747, indicating that it was neither sufficient nor necessary condition. The configuration analysis showed that there were three paths for public hospitals to achieve high social responsibility: co-driven social benefit and appropriateness with high quality assistance, co-driven social benefit and efficiency with high quality assistance, and co-driven appropriateness and efficiency, with a coverage rate of 92.6%.Conclusions:Social benefit, appropriateness, quality, and efficiency can be combined in different ways to achieve high social responsibility in public hospitals. Public hospitals could develop targeted social responsibility improvement strategies according to the actual situation, and strengthen the synergy between the elements to improve the level of social responsibility in hospitals.
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With the continuous advancement of the deepening reform of the medical security system, the medical insurance payment method, as an important part of it, has become the focus of the reform. As one of the main types of innovative payment methods, payment for performance combines payment and medical service quality to improve the efficiency of medical and health services and patient satisfaction. In order to accelerate the clinical application of new medical technologies, improve patients′ access to innovative technologies, and reduce the disease economic burden of patients, Shanghai has carried out a pilot reform of paying for performance for three new technologies including Cryoablation in the treatment of cancer, Da Vinic Robotic Surgical System and Plasma MicroRNA Panel detection. Through multiple rounds of expert consultation and on-the-spot investigation, the positive detection rate, complication rate and tumor reduction rate were finally determined as the performance evaluation indicators of the three technologies, and the corresponding payment standards were defined. The pilot reform in Shanghai could provide reference for other regions to carry out performance based payment.
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Objective:To analyze the cost-effectiveness simulation of medical services for COVID-19 epidemic in Wuhan city based on the social perspective, for the sake of providing references and suggestions to deal with possible public health emergencies in the future.Methods:Through policy documents and literature review, interview survey and Delphi method, the cost and cost-effectiveness of medical services for COVID-19 in Wuhan were simulated based on the decision-tree model, from December 27, 2019 to April 26, 2020.Results:The average curing cost of per patient diagnosed with COVID-19 in Wuhan was 175 462.10 yuan, a figure calculated in the baseline that these epidemic prevention and control measures were taken on January 23, 2020. In Hypothesis 1 (with epidemic prevention and control measures taken one week before), the cost was 164 552.43 yuan, and in Hypothesis 2 (with epidemic prevention and control measures taken one week later), the cost was 187 542.37 yuan. Compared with the baseline, the incremental cost-effectiveness ratio of the medical service for COVID-19 in Wuhan under Hypothesis 1 was 183 000 yuan per patient, which was more cost effective.Conclusions:The public health prevention and control measures played an important role during the COVID-19 epidemic in Wuhan. With the cost-effectiveness simulation results taken into account, this study can provide decision-makers with better references in likewise events.
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Objective:To simulate the cost of medical services for COVID-19 epidemic in Wuhan city from the social perspective, as references and suggestions in case of possible public health emergencies in China in the future.Methods:By such means as policy documents and literature review, interview survey and Delphi method, a cost estimation model was built and confirmed to simulate the cost of medical services for COVID-19 in Wuhan, from December 27, 2019 to April 26, 2020.Results:The total cost of medical services during the COVID-19 epidemic in Wuhan was 8 152 670 867 yuan. 721 800 387 yuan(8.85%) of the medical cost was covered by medical insurance; the medical cost covered by sources other than medical insurance was 434 813 725 yuan(5.34%); the cost of additional measures related to medical service was estimated to be 6 996 056 755 yuan(85.81%).Conclusions:The total cost of medical services during the COVID-19 epidemic in Wuhan was gigantic. The cost estimation results can provide the government with basic information, decision-making basis and suggestions regarding epidemic control.
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Strengthening the performance appraisal of tertiary public hospitals is key to advancing the healthcare system reform in China. Based on the practical experience of performance appraisal of tertiary public hospitals in one city, the authors named the bottlenecks and causes impeding effective implementation of performance appraisal from the aspects of data quality, index orientation, index determination and index calculation. On such basis, they put forward corresponding countermeasures and suggestions, such as effective control of the data quality, dialectical view of the index orientation, scientific allocation of performance indicator weight, and formulation fair and reasonable index scoring methods, aiming to provide references for performance appraisal in the future.
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On March 11, 2020, WHO officially declared that COVID-19 had become Pandemic. As of March 31, the epidemic had affected more than 178 countries and regions, with more than 780 000 confirmed cases. The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits (the 'PIP Framework’ or 'Framework’) is an international arrangement adopted by the World Health Assembly (WHA) in May 2011 to improve global pandemic influenza preparedness and response. Since the transmission route and transmission capacity of COVID-19 are similar to that of influenza A (H1N1) in 2009, which conforms to the basic elements of 'human pandemic', and the epidemic scale has exceeded that of influenza A (H1N1). It is probable to incorporate COVID-19 epidemic response into PIPF, and at the same time to verify and improve PIPF in practice. It is recommended that WHO, other international organizations and relevant countries make full use of the PIPF system to respond to the epidemic and better coordinate national actions at the global level. At the same time, China should also make the planning and deploy of domestic epidemic prevention and control and international epidemic cooperation under the framework.
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OBJECTIVE：To provide reference for the clinical treatment and pharmacoeconomics research of type 2 diabetes patients. METHODS ：Using“Discrete choice ”“Discrete ranking ”as Chinese keywords ，“Discrete choice ”“Discrete ranking ” “Conjoint analysis ”“Diabetes mellitus ”“Type 2”“Type 2 diabetes mellitus ”“Non-insulin-dependent diabetes mellitus ”as English keywords，Chinese and English literatures were retrieved from domestic and foreign databases as CNKI ，Wanfang database ， PubMed，Web of Science during the inception to Dec. 2019. The application status of discrete choice experiment （DCE）was analyzed and summarized from the aspect of attributes and levels ，DCE choice sets ，DCE data quality ，sample size ，econometrics analysis and the preference results. RESULTS & CONCLUSIONS ：A total of 295 related literatures were retrieved ，involving 30 valid literatures. The attributes as drug administration ，glucose control and hypoglycemic events were included more frequently. D-efficient/ D-optimal and orthogonal experiment designs were used more frequently to create the DCE choice sets. DCE data quality could be checked by the internal validity tests. The rules of thumb was usually used to calculate the sample size. Conditional Logit model ，multinomial Logit model or mixed Logit model were used more frequently to analyze the preference data. ZH187） Compared with mild hypoglycemic events ，patients’treatment E-mail：19111020032@fudan.edu.cn choices were more likely to be affected by blood glucose control. However ， when hypoglycemic events occurred at：yychen@shmu.edu.cn night or the degree of hypoglycemia was serious ， the ·treatment preference of patients would change. Although most studies included the drug administration related attributes ，they were not major factors influencing patients ’treatment preferences and were closely related to patients ’previous medication history. DCE had been widely used in the study of type 2 diabetes in foreign countries ，but there were few relevant studies in China. The data quality of DCE was difficult to control. Although the trend of building complex econometric models was gradually rising ，most studies had not fully introduced the design details such as sample size determination method ，option set design principle and quality control option. In addition ，there were some deficiencies such as too many attributes ，too large or too small horizontal spacing. It is suggested that the ten criteria of related research in ISPOR report by Bridges JF and other soholars can be used for reference in DCE design to improve the rigor of design and ensure the credibility of preference results.
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Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′ participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.
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Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.
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Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.
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Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.
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Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.
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Objective To analyze the key factors influencing the number of diseases or conditions in which clinical pathways ( CPs) were implemented at public hospitals of China. Methods Based on the questionnaire survey of 51 public hospitals that had implemented CPs in Shanghai, Hubei province, and Gansu province, a multivariate logistic model was used to analyze the factors that influenced the number of CPs implemented in hospitals. Results In terms of the 14 issues and difficulties found in CPs′implementation, the overall acceptance rate was 38. 8% on average among surveyed hospitals, yet with a great variation(from 7. 1% to 100. 0%). A multivariate logistic model showed that the recognition of public hospitals on the issues and difficulties in CPs′implementation did not affect the number of implemented CPs, and tertiary public hospitals had significantly higher number of CPs implemented than secondary hospitals. Conclusions The resources and management capabilities of public hospitals in China are the determinants of CPs′promotion.
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Objective To analyze the implementation of clinical pathways ( CP) at public hospitals at different levels and in different regions in China. Methods The status of CPs′ implementation at 54 public hospitals in Shanghai, Hubei province and Gansu province was surveyed by questionnaires from March to May of 2015. Results 51 (94. 4%) of the surveyed public hospitals put in place clinical pathway(s), where the average CPs implemented were 45 and the average percentage of the cases using CPs was 52. 7%. There were great variations among these hospitals. In addition, the common diseases with definite diagnostic and treatment options were found with the highest implementation rates of CPs at such hospitals. Conclusions CPs are implemented widely at public hospitals of China, yet enhanced implementation strategies are expected to further CPs′adoption.
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Objective To analyze the management of clinical pathways ( CP) in China. Methods Cross-sectional questionnaire surveys of 51 public hospitals with CPs in place in Shanghai, Hubei province and Gansu province were conducted from March to May of 2015. Results Among the 51 public hospitals with CPs, 48 ( 94. 1%) of them organized training on CPs, 48 ( 94. 1%) of them monitored CPs′implementation, and 40 (78. 4%) applied incentives for CPs′ implementation. But there were some issues and difficulties encountered in CPs′ implementation. Conclusions Comprehensive measures are necessary to improve the management of CPs at public hospitals of China.
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OBJECTIVE:To evaluate the economics of caspofungin vs. voriconazole in initial empirical antifungal therapy of fe-brile neutropenia(FN). METHODS:Based on two international multiple center clinical trials about caspofungin vs. voriconazole in initial empirical antifungal therapy of FN,combined with domestic clinical experts'opinions about drug selection,a decision tree model was developed. TreeAge Pro 2011 software was used to analyze the cost and effectiveness of 10-day therapy of caspofungin or voriconazole as initial empirical antifungal therapy. RESULTS:The direct medical cost of caspofungin group was lower than that of voriconazole group(52826.71 yuan vs. 58246.70 yuan). The success rate and survival rate were higher than voriconazole group(33.95% vs. 25.63%、92.36% vs. 91.87%). Whether the success rate or the survival rate of patients as the effect indicators, cost-effectiveness ratio of caspofungin group was lower than that of voriconazole group. Moreover,incremental cost effectiveness ra-tio and sensitivity analysis confirmed this conclusion. CONCLUSIONS:Caspofungin has more advantages than voriconazole in cost and effectiveness as initial empirical antifungal therapy in patients with FN.
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Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.
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Objective To explore the key factors of public hospital regulation and the impact factors for such regulation,and to provide reference for improvement.Methods Multi-input precedence chart was used to identify the key factors,and decision making trial and evaluation laboratory was used to analyze impact factors on the regulation.Results Such preference charts as medical behavior,quality and patient safety,and admittance scored over 60 points,thus ranking key factors of regulation on public hospitals.Those factors affecting the outcomes of regulation,namelydefective legal system,poor management system, and diversification and fragmentation of supervision entities, as well asincapable supervisors scored greater than 0,ranking as the cause factors.Conclusions The key content and factors related to effect of regulation could be used to improve regulation.In the course of reform of the regulation mechanism,the regulation outcomes could be improved with focus on key regulation factors and main cause factors.
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Thalassemia is a genetic disease with a high-incidence rate which has influenced the health condi-tions of newborns in south China. In this paper, we analyze the policy process of thalassemia prevention strategy in Guangxi based on John Kingdon’s policy stream theory, discussing the problem, policy and political flows of the strat-egy and analyzing how does the policy window open. We found that the thalassemia prevention policy was based on the deep understanding of the women and children’s health conditions, and the policy entrepreneur had made a pro-gram for alleviating to and eradicating the problem. In the condition of deepening health system reform, the thalasse-mia prevention policy in Guangxi had attracted the attention of policy makers. At a right political time for policy-mak-ing, the three above mentioned flows came in bond pushing the policy window open. As long as the thalassemia pre-vention policy process is analyzed based on the policy stream theory, it could be a good theoretical and practical ex-ample for other public health policy analysis in China.