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As one of the flexible means of drug supervision， the “compassionate medicine use system” has become a new way to meet the drug accessibility of patients at present. The “compassionate medicine use system” in Britain， that is， Early Access to Medicine Scheme， intervenes in the drug development process of the applicant enterprises at an early stage through the cooperation of different government departments， which not only ensures patients obtain innovative drugs in time， but also accelerates the drug listing and payment and reimbursement process. At present， China has only made principled provisions on the “compassionate medicine use system”， but has not issued specific implementation rules. It is suggested that the access conditions of “compassionate medicine use”， the responsibilities and obligations of different subjects， the payment mechanism of expenses and how to promote the cooperation of relevant departments should be clearly defined as soon as possible in combination with the system experience of Britain， so as to form a standardized and operable “compassionate medicine use system” suitable for China’s national conditions.
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The rise of internet thinking, along with the growing acceptance of the " patient-centered" concept, has played a significant role in driving the development of electronic patient-reported outcomes (ePROs) in the field of clinical evaluation. While several large-scale and well-established ePROs evaluation systems have been widely adopted and implemented worldwide, China has lagged behind in ePROs research and electronic application. Therefore, the purpose of this paper is to comprehensively analyze and summarize the concepts, types, characteristics, state of development, and application of ePROs. Specifically, it focuses on analyzing the structure and content of ePROs evaluation network systems in the United States, France, and the United Kingdom. The ultimate objective is to provide insightful analysis and useful suggestions to aid in the development and evolution of ePROs in China.
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The achievements of the national health informatization of China have been remarkable while still facing various challenges,including infrastructure,overall coordination,technical specifications,network security,and public health risks.By conducting a comparative study of the information management of the top 5 best hospitals in the world in 2021,it identifies that for the future of hospital information construction,there is a need for deepening the application of core scenarios such as electronic medical records,mobile medical care,and telemedicine.Further-more,there is a need to expand technology development at the terminal layer,network layer and platform layer.The key to accelerating the construction of national health information is closely integrating the application require-ments of hospital information management with the development trend of intelligent technology.
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Objective To explore the effect of the utilization of National Basic Public Health Service (NBPHS) on the regular medication behavior and glycemic control of patients aged 35 and over with type 2 diabetes, and to provide support for the health management practice of type 2 diabetes patients in China. Methods Based on the multi-stage stratified sampling method, a questionnaire survey was conducted in 10 community health service centers or township health centers in Zhejiang Province, Shanxi Province and Chongqing City in China from November to December 2019. The data of socio-demographic characteristics, utilization of NBPHS in the last year, regular medication in the last six months and glycemic control were collected. The effect of NBPHS utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression. Sensitivity analysis was carried out using the multilevel logistic method and the total score calculation method for basic public health services in different countries. Results A total of 1 527 patients with type 2 diabetes aged 35 and over were recruited, 41.00% were male, 66.08% were aged 65 years old and above, and 39.64% were ill for 10 years and over. The survey showed that the regular medication rate was 89.26%, the glycemic control rate was 65.23%, and the score on utilization of NBPHS was 11.83±2.246 (range 0-15). With the more utilization of NBPHS, regular medication rate in patients with type 2 diabetes increased (χ2trend=4.816, P2trend=0.080, P>0.05). The multivariate regression analysis showed that secondary school and above (OR=2.20), longer duration of disease (OR5-9 years=1.62, OR10 year and above=3.92) and higher utilization score of NBPHS (ORQ3=2.01) were protective factors for the regular medication. Compared with the local household registration population, the local resident population (OR=0.54) was a risk factor for regular medication. Unmarried or divorced or widowed (OR=0.61) and longer course of disease (OR10 year and above=0.60) were risk factors for satisfactory glycemic control, while increased monthly income per household (OR2000-5000 yuan=1.52, ORMore than 5000 yuan=1.76) was a protective factor for satisfactory glycemic control. Conclusion The utilization of NBPHS has promoted the regular medication rate of patients with type 2 diabetes, and the higher utilization takes better effect. Emphasis should be paid on patients with low education level, non-local household registration, short course of disease, and no partner. At the same time, it is necessary to strengthen the utilization of NBPHS to promote the change of their health awareness and health behavior..
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Objective:To assess the progress and impact of the China Healthcare Improvement Initiative(CHII) from 2015 to 2020, which aimed at improving patients healthcare experiences.Methods:Five rounds of evaluation surveys were conducted from December 2015 to March 2021 among 136-214 tertiary public hospitals. Structured questionnaires to measure hospital actions and performance, satisfaction of patients and medical staff were designed, and the data were collected by the national and provincial survey teams via onsite inspection, face-to-face/telephone interviews and self-administered cellphone APPs respectively. After data cleaning, the results of five round evaluations were analyzed and compared.Results:The sampled hospitals demonstrated high participation rate in the CHII, and their overall performance turned out to be satisfactory. And the patient healthcare experiences consistently improved over the period of CHII. In contrast to the high satisfaction rate with clinical quality of the sampled hospitals, patients were less satisfied with the non-clinical services such as food and supporting services. The job satisfaction of doctors and nurses experienced mild improvements, while the problems of heavy workload, low salary, and poor health were not effectively solved yet.Conclusions:The implementation of CHII from 2015 to 2020 has played a significant role in promoting patient-centered service models in hospitals, but continuous inputs and coordinated efforts are still required in the future. The improvement of non-clinical services still needs to be addressed to further enhance patient satisfaction. The job satisfaction and well-being of doctors and nurses remain at low level, and effective measures need to be taken to maintain the stability of the medical staff.
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Objective:To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods:In March 2019 and from January to March in 2021, 143 tertiary public hospitals in 31 provinces of China were investigated using the unified " medical institution questionnaire Ⅰ" and " medical institution Questionnaire Ⅱ" . The data were collected by means of hospital self-report and expert on-site scoring. Descriptive and inferential statistical analysis were used to analyze the data, and the data of two cross-sectional surveys were compared and analyzed.Results:The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%, which was higher than that in 2018(84.4%). The appointment diagnosis and treatment system, clinical pathway management system, day service, smart hospital and humanistic service were significantly improved. In 2020, the average score rate of logistics service, high quality nursing service and clinical pathway management system was higher than 95%, while the average score rate of day service, telemedicine system and medical social work system was lower than 85%. The total score rate of general hospitals was significantly higher than that of specialized hospitals( P<0.001). In 2020, the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%, reaching the standard level. Conclusions:The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress, but some dimensions and indicators need to be further improved.
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Objective:To explore the change trend of patients′ recognition of the medical reform effect and medical staff′s occupation and its relationship with medical experience, since the implementation of the China Healthcare Improvement Initiative(CHII), so as to provide reference for exploring the breakthrough point of consolidating the reform effect.Methods:Four indicators of the third-party assessment of patients were selected, which were " I think the medical reform has benefited patients" , " I think the doctor-patient relationship is improving in the past three years" , " I think medical personnel deserve social respect and recognition" , and " I am willing to let my children join the medical profession" . Descriptive and trend analysis were carried out on the survey results, and correlation analysis was carried out between the survey results and patients′ medical experience.Results:Compared with the baseline evaluation results(76.9% and 69.9%for outpatients, 87.3% and 85.6%for inpatients), the patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship in the fifth evaluation(86.2% and 89.1%for outpatients, 91.4% and 92.6%for inpatients)were significantly improved. The proportion of patients who thought the medical staff was worthy of respect and willing to let their children work in the hospital in the fifth evaluation(97.4%, 79.1%for outpatients, 98.7%, 85.1%for inpatients)were higher than the baseline evaluation results(92.3%, 71.0%for outpatients, 98.1%, 81.6%for inpatients). The above indicators were positively correlated with the patient′s medical experience.Conclusions:Since the implementation of CHII, patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship has been continuously improved, and patients′ respect and recognition of professional identity of medical personnel is at a high level and continues to improve. Improving medical experience has a positive effect on the improvement of patients′ sense of medical reform.
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Objective:To summarize the progress and achievement of outpatient experience improvement in tertiary public hospitals from 2016 to 2021, so as to provide basis for further improving outpatient experience and raising outpatient satisfaction.Methods:Based on 5 round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the outpatient process and outpatient satisfaction, and stratified analysis was conducted on patient satisfaction in different regions and different types of institutions.Results:One hundred and thirty-six core sample hospitals were included in the 5 round evaluation, and 30 153 valid questionnaires were collected in the fifth evaluation in 2021.From 2016 to 2021, the overall satisfaction of outpatients in the 5 round evaluations was 91.4%, 87.3%, 90.1%, 91.1% and 95.4%, respectively. The satisfaction of outpatients to the medical services continued to improve. Outpatient treatment process has been continuously optimized, appointment registration has become the most commonly used way of outpatient registration. The satisfaction of outpatients to the process and environment of treatment in the western region was significantly improved.Conclusions:From 2016 to 2021, the overall satisfaction of outpatients has been consistently improved. Informatization helps to optimize the treatment process, but it is recommended that hospitals should provide special support for elderly outpatients.
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Objective:To summarize the progress and achievement of inpatient experience improvement in public hospitals in China from 2016 to 2021, so as to provide basis for further improving hospitalization experience and raising inpatient satisfaction.Methods:Based on the five Third-party Evaluations of China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on inpatient process, cost and inpatient satisfaction, and the inpatient satisfaction in different regions and different types of institutions was compared.Results:The overall satisfaction of hospitalized patients in the fifth evaluation in 2021(98.5%)was higher than that in the first evaluation in 2016(96.2%). The western region and maternal and child institutions had the most obvious improvement in the comparison of regional and institutional types. The improvement of inpatients′ satisfaction with diet was not obvious. Inpatients were most dissatisfied with " high medical expenses" , " cumbersome procedures" and " long waiting time for bed" .Conclusions:From 2016 to 2021, the satisfaction of hospitalized patients has been consistently improved, but there is still room for improvement in non-medical services. Hospital meals for inpatient and relief of inpatient healthcare financial burden are the priorities for healthcare improvement and raising hospitalization satisfaction in the next stage.
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Objective:To analyze the status quo, trend and influencing factors of patient satisfaction in tertiary maternity and child hospitals in China.Methods:Based on the survey results of five round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the satisfaction index in tertiary maternity and child hospitals, and the influencing factors of satisfaction were analyzed based on the results of the fifth evaluation.Results:Compared with the first round, the overall patient satisfaction in tertiary maternity and child hospitals in the fifth round was improved(inpatient: from 95.7% to 98.0%; outpatient: from 87.8% to 94.9%). Outpatient satisfaction varied significantly among gender, hospitals of different types, education level, types of treatment, medical insurance and doctors′ titles( P<0.05). Outpatient satisfaction in local hospitals was 1.502 times higher than that in hospitals under the National Health Commission. The satisfaction of referrals was 0.259 times lower than that of patients who were admitted directly. Inpatient satisfaction varied significantly among department, hospitals of different regions, household registration type and whether the admission was delayed due to the COVID-19 epidemic( P<0.05). The satisfaction of inpatients in medical ward and surgical ward was respectively 0.202 and 0.298 times lower than that of inpatients in pediatric ward. Inpatient satisfaction at the central regions was 3.311 times higher than that at the eastern regions. Conclusions:The overall patient satisfaction in tertiary maternity and child hospitals in China is improving. In the future, we should pay more attention to the hospital environment, humanistic care and other non-medical service dimensions with low satisfaction, so as to further improve the medical experience of patients in maternity and child hospitals.
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Objective:To investigate the patient satisfaction at tertiary cancer hospitals in China, and explore its determinants.Methods:Based on the fifth third-party evaluation of China Healthcare Improvement Initiative, an inpatient satisfaction survey was conducted from January 2021 to March 2021 in 33 tertiary cancer hospitals in China. Inpatient satisfaction was analyzed, and Chi-square test and binary multivariate logistic regression were run, using the level of overall inpatient satisfaction as a dependent variable.Results:A total of 5 417 inpatients in tertiary cancer hospitals was recruited with 49.8% men. The inpatient at the age of 35-59 accounted for 56.0%, and they were 52.8±13.9 years old. The level of overall inpatient satisfaction was 98.90%. The inpatient satisfaction rates of meal service, waiting time for admission and psychological counseling service provided by hospital were relatively poor, which were 78.75%, 92.40% and 94.11%, respectively. The regression showed that level of overall inpatient satisfaction in the central and western regions(compared with eastern area), with urban and rural residents basic medical insurance or other type(compared with urban employee basic medical insurance), of breast cancer patients(compared with other disease), with unsured postoperative metastasis(compared with non-postoperative metastasis), with low self-rated health score(compared with the score of between 81 and 100)was lower.Conclusions:The inpatients in tertiary cancer hospitals in China is highly satisfied with the care provided. In the future, more attention should be paid to the dimension of lower patient satisfaction, such as diet and psychological counseling.
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Objective:To analyze the current level and dynamic change of the salary and income satisfaction rate of doctors in Chinese tertiary public hospitals in recent years.Methods:In January 2018, March 2019 and March 2021, the project team of " the third party evaluation of the China Healthcare Improvement Initiative" conducted a questionnaire survey among doctors of 136 tertiary public hospitals in 31 provinces. The first-line clinicians were investigated by stratified sampling method. The salary level and satisfaction of doctors were investigated by questionnaire. Chi square test was used for comparison between groups.Results:The sample size of the three surveys was 20 786, 23 289 and 22 836 respectively. The median value of doctors′ actual income after tax in 2017, 2018 and 2020 was 100 800 yuan, 120 000 yuan, 150 000 yuan respectively, and the median expected annual income after tax was 196 000 yuan, 250 000 yuan and 250 000 yuan. The proportion of doctors satisfied with the current income was 16.5%, 17.8% and 26.9% respectively. The salary and satisfaction rate of doctors had an upward trend, but the overall level was still low.Conclusions:In recent years, the salary of doctors in tertiary public hospitals in China has been improved to a certain extent, but on the whole, it is at a low level, and there is still much room for improvement. In the future, the government needs to improve the hospital salary system and increase the salary of doctors continuously, especially needs to pay attention to the doctors with high education level and intermediate titles.
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Objective:To analyze the salary level, change trend and salary satisfaction of nurses in tertiary public hospitals in China.Methods:The data was derived from three round third-party evaluation of the China Healthcare Improvement Initiative at 136 tertiary public hospitals from December 2017 to January 2018, March 2019 and January to March 2021. The self-reported salary, expected salary and salary satisfaction rate of nurses were analyzed.Results:The sample sizes of the three evaluations were 27 575, 27 568 and 25 197, representing the salary situation in 2017, 2018 and 2020 respectively. In 2017, 2018 and 2020, the actual average annual salary of nurses was 81 600 yuan, 100 000 yuan and 110 000 yuan respectively, the expected average annual salary was 140 000 yuan, 160 000 yuan and 160 000 yuan respectively, and the ratio of expected salary to actual salary was 1.72, 1.60 and 1.45 respectively. In 2017, 2018 and 2020, the proportion of nurses satisfied with their current income was 34.0%, 33.7% and 43.6% respectively. In 2020, nurses in the eastern region, other specialized hospitals, senior professional titles and graduate degrees had highest annual salary.Conclusions:The salary level and satisfaction rate of nurses in tertiary public hospitals in China show a slow growth trend, and the gap between actual salary and expected salary is gradually narrowing.
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Objective:To understand the changes in the practice environment from the perspective of doctors in 136 tertiary public hospitals, and to provide evidence for formulating strategies and measures to improve the practice environment of doctors.Methods:The data was collected from five rounds of China Healthcare Improvement Evaluation Survey from December 2015 to March 2021. The sample size was 17 945, 19 774, 20 786, 23 289, and 22 836, with a total of 104 630. The self-designed questionnaire on four dimensions of doctor-patient relationship, workload, administrative logistics support and professional identity was performed.Results:From the 1st to the 5th survey, the approval ratio of " the administrative and logistics department of this hospital is highly efficient" showed the characteristics of " U-shaped distribution" , and the approval ratio of " approve or encourage children to continue to engage in medical work" increased from 13.38% to 23.91%.From the 2nd to the 5th survey, the percentage of doctors who experienced doctor-patient disputes dropped from 28.96% to 23.20%, and the percentage of doctors agreeing that the relationship between doctors and patients in this hospital was improving continued to increase from 33.20% to 60.45%.From the 3rd to the 5th survey, the proportion of doctors experiencing medical troubles dropped from 15.10% to 14.19%, and the recognition rate of " the cafeteria of this hospital provided medical staff with nutritious and delicious meals" increased from 36.25% to 47.52%, and the approval proportion of " my current work load is heavy" dropped from 61.55% to 45.24%. The results of the 5th survey showed that there were significant differences in the approval ratios of each dimension in different genders, job titles and hospital types( P<0.001). Conclusions:From the perspective of doctor-patient relationship, workload, administrative logistics support, and professional identity, the improvement of doctors′ practice environment is still insufficient. Hospital administrators should continue to focus on the improvement of the doctor-patient relationship, and take necessary measures to reduce doctors′ workload and improve doctors′ professional identity.
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Objective:To analyze the practice and experience of " patient-centered, popularizing multi-disciplinary team(MDT) mode" in medical institutions, and to put forward reasonable suggestions and opinions for medical institutions to further improve and popularize MDT mode.Methods:Based on the evaluation of China Healthcare Improvement Initiative, 40 typical cases of MDT in medical institutions were collected, and descriptive analysis and textual analysis were carried out on the cases.Results:There were more specialized hospitals carrying out MDT, the application scope of MDT services was constantly expanding, and the management system and diagnosis and treatment process were constantly optimized.Conclusions:The mode of MDT in China is in the stage of exploration and development. In the promotion process, it is necessary to give full play to the role of information means, establish scientific and reasonable cost measurement and charge standard, and improve the enthusiasm of medical institutions and medical personnel to participate in MDT.
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Objective:To understand the practice of humanistic care and social worker voluntary service in public hospitals in China.Methods:From January to March 2021, 38 typical cases concerning " medical social worker and volunteer system" and " building a harmonious doctor-patient relationship through humanistic service" were collected by relying on the evaluation of China Healthcare Improvement Initiative. By means of statistics on the frequency of the subject words in the cases, hotspots of these hospitals in " paying attention to medical humanistic care and promoting social work voluntary service" were identified.Results:By classifying the keywords of the 38 cases, the hotspots mainly focused on strengthening the construction and management of social work volunteer platform and team, providing convenient and high-quality services, integrating humanistic care into diagnosis and treatment services, and building characteristic brand projects.Conclusions:The concept of humanistic care should be integrated into the hospital culture construction, the standardized and institutionalized development of humanistic care and volunteer work in the hospital should be promoted. Supporting measures should be introduced to promote the professional and stable development of talent team, and the routine service system should be established based on the needs assessment of both doctors and patients.
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Background: Despite strengthened efforts on human immunodeficiency virus (HIV) prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV-prevention tool, has recently been included in China's Action Plan of HIV Prevention and Control. To promote future PrEP implementation, this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods: In 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a seven-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a seven-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention. Results: Overall, 44.67％ of the participants had more than two male sexual partners and 5.56％ had HIV-positive sexual partners. Only 57.00％ had heard of PrEP and only four (1.33％) participants had used PrEP. However, 75.34％ expressed the willingness to use oral PrEP if its efficacy was assured. The beliefs that "PrEP can prevent HIV if taken as prescribed" (adjusted odds ratio (AOR) = 4.84, P < 0.001) and "PrEP can be scaled up in the community" (AOR = 3.24, P < 0.001) were positively associated with oral PrEP use intention. Concerns of side effects were negatively associated with oral PrEP use intention (AOR = 0.32, P = 0.006). Further, 77.00％ of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, "Not certain if doctors can prescribe PrEP if I go to the clinic" was positively associated with the intention to use injectable or implanted PrEP (AOR = 3.03). The items "Heard of PrEP" (AOR = 2.74) and "PrEP can prevent HIV if taken as prescribed" (AOR = 2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67％) and side effects (38.67％). The most common reasons for using injectable and implanted PrEP were adherence (81.94％ and 77.86％, respectively) and privacy concerns (56.48％ and 55.00％, respectively). Affordable price and coverage by health insurance were the driving factors for PrEP use. Conclusion: Given the low level of awareness of PrEP-related information in China, it's necessary to provide interventions for high-risk individuals and communities, in order to increase their awareness and knowledge of PrEP. Furthermore, additional alternatives to HIV prevention, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Even if this programme could be approved by the National Medical Products Administration of China and implemented, a supportive social environment for MSM is essential during its implementing.
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Objective:To explore the impact of the clinic-pharmacy separation reform in Beijing on the outpatients with medical insurance.Methods:A segmented regression model of interrupted time series(ITS)data was used, to analyze the changes from April 2017 to May 2019 in outpatient visits, average cost per visit, out-of-pocket burden, with a tertiary hospital in Beijing as an example before and after the reform.Results:Segmental regression analysis showed that since the reform, the out-of-pocket burden of outpatients fell by 5.2% in the first month. After the reform, the medicine expenses decreased 0.50 yuan monthly instead of increasing 0.24 yuan before, and the surgery expenses, examination and laboratory fees, and materials expenses have increased from an average monthly increase of 0.14 yuan, 0.64 yuan and 0.36 yuan to 0.15 yuan, 0.70 yuan and 0.17 yuan respectively. Meanwhile, the growth rate of outpatient services slowed down, with an increase number dropping from 855 visits/month to 523 visits/month.Conclusions:The reform had reduced the out-of-pocket expenses of outpatients.
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Objective To assess the effectiveness of China Healthcare Improvement Initiative from 2015 to 2017.Methods The 3rd round evaluation was conducted from December 2017 to January 2018 at 136 tertiary public hospitals, and the results were compared with the previous two surveys. Hospital Questionnaire, Patient Questionnaire and Doctor-Nurse Questionnaire were designed and administered by experts, onsite investigators and self-administered cellphones respectively. Data were analyzed by SPSS software.Results In 2017, the hospital performance scoring of these hospitals was 91.77% , which rose steadily from 2015 and 2016.Significant dimensions scoring the highest included the appointment system, rational allocation of medical resources and IT use.Overall patient satisfaction remained over 90% with both outpatients and inpatients. Defects however remained in such areas as long waiting time, insufficient communication between doctors and patients.Heavy workload was common among medical staff, in addition to poor staff welfare and poor health, resulting in declining job satisfaction.Conclusions The Initiative has made significant progress in the past 3 years, while there still remain some important challenges.Substantial improvement of the welfare and job satisfaction of medical profession deserves a top priority in healthcare reform in the future.
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Objective To assess the implementation of Healthcare Improvement Initiative ( the Initiative)by 136 tertiary hospitals nationwide in 2017, and provide reference for improving relevant policies. Methods Hospital questionnaires 1 and 2 were designed, and data were collected by self-report and expert scoring.Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H(K), and Spearman rank correlation were used for statistical analysis.Results The median score of the first 11 dimensions of these hospitals was 91.89% , and that of the first 12 dimensions of 30 women and children hospitals was 90.54%.The total score rate of the top 11 hospitals in the eastern region was higher than that of both the central region and western region(P<0.001).The total score rate of the first 12 dimensions of women and children′s hospitals in the eastern region was higher than that in the central and western regions(P=0.032).The total score rate of the first 11 dimensions of the national level hospitals was higher than that of the local hospitals ( P =0.004).The correlation coefficient between the total number of patients and the total score of the first 11 dimensions and the first 12 dimensions was 0.578 and 0.413, respectively.Conclusions Implementation of the Initiative is satisfactory in general. There are however still rooms of improvement for hospitals in the central and western regions, and local level hospitals as well. General hospitals are better than TCm and specialist hospitals.The larger the scale, the better the performance in service improvement.
