Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study

Family participation in geriatric decision-making: Marginalization of older patients' autonomy in Chinese outpatient consultation

Family participation is regarded as crucial for promoting patient well-being, particularly in geriatric care, where patients often face greater challenges and require additional support in making medical decisions. The importance of family participation is frequently framed within a cultural context that acknowledges differing conceptions of autonomy. However, it remains unclear how family members are actually prompted or discouraged in their participation in medical decision-making. This article aims to identify the interactional patterns of decision-making during accompanied geriatric consultations and to examine the underlying mechanisms shaping these dynamics. Focusing on audio recordings of 86 geriatric encounters, the mixed-method study identified four decision-making patterns through nuanced Conversation Analysis: direct family surrogation, substitute family surrogation, and patient-centered collaboration. A subsequent quantitative analysis was conducted to explore factors influencing these decision-making patterns, in which the identity of the companion emerged as a key factor shaping interactional dynamics, with adult children being significantly more likely to assume a surrogate role than spouses. These findings are discussed in the context of the broader social structure of elder care and the institutional constraints present in the Chinese medical system. This study emphasizes the need for caution in overemphasizing cultural characteristics, as doing so risks systematically marginalizing the social agency and self-efficacy of older adults. We call for greater efforts to ensure the meaningful participation of older individuals in healthcare decisions.

The budget impact analysis of nicotine replacement therapy among patients who smoke tobacco and have mental illness in South Africa and the implications

BACKGROUND

Tobacco use is the world's leading preventable cause of death, with the highest burden in low and middle-income countries (LMICs). Those who have mental illness are particularly vulnerable, with a smoking rate two to five times higher than that of the general population. Quitting smoking has demonstrated benefits for mental health, including reducing stress and improving the quality of life. However, the economic feasibility of introducing Nicotine Replacement Therapy (NRT) in the psychiatric medical environment in South Africa has not yet been explored. This study aims to address this gap by assessing the impact on the budget of implementing an NRT-based smoking cessation program in a psychiatric hospital.

METHODS

This retrospective and cross-sectional study followed a budget impact analysis framework. Data were retrieved between May 19 and Aug 18, 2023, from 214 patients' medical records. Using primary and secondary data, an ingredients costing approach was used to estimate direct treatment costs of NRT smoking cessation. All costs were expressed in ZAR (South African currency). The economic evaluation was conducted from the payer's perspective, and the results were reported at a 5% discount rate. A two-way 10% sensitivity analysis was conducted.

RESULTS

The study showed that study participants were primarily black, male, unemployed, diagnosed with schizophrenia and smoked lightly (69.16% ±3.46). Implementing the 3-month treatment period of NRT smoking cessation program would result in an expenditure of R1 478 915.42 for 214 patients. The hospital will require an additional 0.15% (±0.0095) of the total hospital budget and 6.09% (±0.31) of the hospital pharmacy budget.

CONCLUSION

Our findings indicate that while implementing a NRT is crucial for improving the overall health outcomes among patients with mental illnesses, substantial investment would be required. The budgetary allocation for NRT smoking cessation interventions would vary by treatment settings and program duration. Consequently, careful consideration of budget allocation and resource distribution is necessary to ensure the program's sustainability within the broader healthcare framework in South Africa.

Status of cardiovascular magnetic resonance in clinical application and scientific research: a national survey in China

BACKGROUND

Cardiovascular magnetic resonance (CMR) is rapidly expanding in China, yet comprehensive national data on its clinical application and research status are limited. This study aims to evaluate the current landscape of CMR across the country.

METHODS

An electronic survey was conducted targeting the following two groups: physicians trained at the Fuwai Fellowship Program and members of the Chinese Society of Radiology. The survey encompassed details on CMR equipment, clinical practices, and research activities.

RESULTS

Of 248 hospitals responded to the survey, 98.0% (243/248) were tertiary centers. The number of scanners distributed unevenly across geographic regions, with Central South China leading with 5.9/center. Siemens, Philips and GE were top three scanner vendors. Most centers initiated CMR program post-2015. Coronary artery disease was the primary indication for CMR. The median annual volume was 120/center. High-volume centers unevenly concentrated most CMR cases. The weighted average waiting period was 14.2 days, while scan durations ranged from 40 to 60 min. Two thirds of hospitals used post-processing software to analyze imaging. Half of responding centers included T1 and T2 mapping in clinical routine, but stress perfusion was underutilized in both clinic and research. Approximately one-third of centers had published CMR-related research. The majority of physicians were confident about the development of CMR. Major barriers to CMR development included long scan times, high costs, insufficient equipment, and limited training.

CONCLUSION

CMR is experiencing rapid growth in China but faces significant regional disparities in access to technology and expertise. Efforts to reduce costs, improve training, and expand access to advanced techniques are crucial for balanced development.

Impact of offline experiences on consumer decisions: Balanced vs. unbalanced social exchange in switching to online health services

Objective

The diffusion of online health consultations (OHCs) depends on consumers switching from offline to online channels; consumers' offline experience on health servicer determines their decisions. Our research aims to address this gap in the literature by examining how offline experiences of doctor-patient interactions influence online switching intentions.

Methods

We conducted online surveys, and 662 samples were collected and analysed the data using structural equation model via SmartPLS. Drawing on social exchange theory, we divided offline experience into balanced (discrete and relational social exchange) and unbalanced social exchange (doctor power and patient compliance). In accordance with the dedication-constraint model, perceived value and offline habit were defined as dedication and constraint factors, respectively; the influence of offline experience on both dedication and constraint factors was revealed. Moreover, we introduced the moderation effect to reveal the boundary of the effect of offline experience.

Results

Our findings showed that balanced social exchange increases consumers' perceived value towards OHC, whereas unbalanced social exchange increases offline habit. Additionally, we observed a positive association between perceived value and the intention to switch, whereas offline habits had a negative impact. Online trust, as a moderator, strengthens the relationship between balanced exchange and perceived value and weakens the relationship between unbalanced exchange and offline habits. These results establish a theoretical framework for comprehending cross-channel switching in online health service marketing.

Conclusions

Since offline experience of doctor-patient interactions influences consumers' decisions, it is critical for online health service platforms to apply cross-channel integration strategy rather than depend on online channels alone.

Exploring experiences and perspectives of patients on hypertension management in Southern Ethiopia: a phenomenological study

BACKGROUND

Hypertension is a significant public health challenge, particularly in low- and middle-income countries, where its management is often inadequate. Understanding patients' experiences and perspectives is crucial for improving hypertension care. Despite a growing body of literature on hypertension in Ethiopia, most studies focus on quantitative data, leaving a significant gap in qualitative insights into patient experiences and perspectives. This study uniquely contributes to the field by exploring the lived experiences of patients in Southern Ethiopia, providing context-specific evidence to inform patient-centered hypertension management strategies.

OBJECTIVE

This qualitative study aimed to explore the experiences and perspectives of patients with hypertension regarding their management and care at a comprehensive hospital in Southern Ethiopia.

METHODS

A phenomenological approach was employed to capture the experiences and perspectives of participants. In-depth interviews were conducted with 14 patients with hypertension, selected through purposive sampling. The interviews were audio-recorded, transcribed verbatim, and analyzed using OpenCode version 4.02 software to facilitate systematic coding and thematic analysis. Then, key themes and subthemes were identified from the data related to patient experiences and perspectives providing a relevant framework for understanding the complexities of hypertension management from the patients' perspectives.

RESULTS

The six key themes emerged, depicting participants' challenges, coping strategies, and interactions with the healthcare system. The themes identified are: adherence to treatment and self-care, awareness of perceived risk and health literacy, experience with the diagnosis, family support in hypertension management, stress awareness and management, and healthcare system and proximity to facilities. Participants noted obstacles to adherence, including long waiting times, forgetting medications, and stress related to their condition. CONCLUSION AND RECOMMENDATION: The findings highlight the need for specific patient-centered strategies that address the challenges faced by hypertensive patients in Southern Ethiopia, such as reducing wait times, enhancing family involvement in care, increasing adherence, and addressing stress. Strengthening healthcare services is essential for sustainable hypertension management.

Evolution of the "Internet Plus Health Care" Mode Enabled by Artificial Intelligence: Development and Application of an Outpatient Triage System

BACKGROUND

Although new technologies have increased the efficiency and convenience of medical care, patients still struggle to identify specialized outpatient departments in Chinese tertiary hospitals due to a lack of medical knowledge.

OBJECTIVE

The objective of our study was to develop a precise and subdividable outpatient triage system to improve the experiences and convenience of patient care.

METHODS

We collected 395,790 electronic medical records (EMRs) and 500 medical dialogue groups. The EMRs were divided into 3 data sets to design and train the triage model (n=387,876, 98%) and test (n=3957, 1%) and validate (n=3957, 1%) it. The triage system was altered based on the current BERT (Bidirectional Encoder Representations from Transformers) framework and evaluated by recommendation accuracies in Xinhua Hospital using the cancellation rates in 2021 and 2022, from October 29 to December 5. Finally, a prospective observational study containing 306 samples was conducted to compare the system's performance with that of triage nurses, which was evaluated by calculating precision, accuracy, recall of the top 3 recommended departments (recall@3), and time consumption.

RESULTS

With 3957 (1%) records each, the testing and validation data sets achieved an accuracy of 0.8945 and 0.8941, respectively. Implemented in Xinhua Hospital, our triage system could accurately recommend 79 subspecialty departments and reduce the number of registration cancellations from 16,037 (3.83%) of the total 418,714 to 15,338 (3.53%) of the total 434200 (P<.05). In comparison to the triage system, the performance of the triage nurses was more accurate (0.9803 vs 0.9153) and precise (0.9213 vs 0.9049) since the system could identify subspecialty departments, whereas triage nurses or even general physicians can only recommend main departments. In addition, our triage system significantly outperformed triage nurses in recall@3 (0.6230 vs 0.5266; P<.001) and time consumption (10.11 vs 14.33 seconds; P<.001).

CONCLUSIONS

The triage system demonstrates high accuracy in outpatient triage of all departments and excels in subspecialty department recommendations, which could decrease the cancellation rate and time consumption. It also improves the efficiency and convenience of clinical care to fulfill better the usage of medical resources, expand hospital effectiveness, and improve patient satisfaction in Chinese tertiary hospitals.

Mobile Patient-Provider Communication and Lifestyle Improvement: Examining the Role of Mobile Technology Identity and Health Empowerment

In the span of a decade, smartphones have gained popularity and acceptance among both patients and physicians thanks to their advantages in health care delivery. However, research investigating mobile patient-provider communication (MPPC) and its impact on patients' lifestyles is only just beginning. Drawing on the pathway model of health communication and mobile technology (MTI) theory, we developed a research model to explore the effect of MPPC on lifestyle improvement, using health empowerment as a mediator and MTI as a moderator. The findings from 432 participants (Mage = 32.5 years old, female = 212) suggested that after controlling for respondents' age, gender, education, income, and general health status, having greater communication with healthcare providers through mobile devices was positively related to lifestyle improvement and that health empowerment mediated this relationship. Moreover, MTI-emotional energy (MTIE) moderated the direct relationship between MPPC and lifestyle improvement, while MTI-dependency (MTID) moderated the indirect impact of MPPC. Individuals who hold a greater MTIE/MTID were more likely to benefit from MPPC such that they are more likely to be empowered for self-care and maintain healthy lifestyles. This study not only contributes to the growing literature on mobile health communication but also plays a reference role for interventions in patient empowerment and health promotion. Theoretical and practical implications were discussed.

Mapping evidence on the factors contributing to long waiting times and interventions to reduce waiting times within primary health care facilities in South Africa: A scoping review

BACKGROUND

Globally, reduction of patient waiting time has been identified as one of the major characteristics of a functional health system. In South Africa, 83% of the general population visiting primary healthcare (PHC) facilities must contend with long waiting times, overcrowding, staff shortages, poor quality of care, an ineffective appointment booking system, and a lack of medication. These experiences may, in turn, affect how patients view service quality.

METHODS

This scoping review was guided by Arksey and O'Malley methodological framework. The primary literature search of peer-reviewed and review articles was achieved through PubMed/MEDLINE, Google Scholar, Science Direct, and World Health Organization (WHO) library databases, using waiting times, outpatient departments, factors, interventions, and primary healthcare facilities as keywords. Two independent reviewers screened abstracts and full articles, using the set inclusion and exclusion criteria. We used NVIVO® version 10 software to facilitate thematic analysis of the results from included studies.

RESULTS

From the initial 250 records screened, nine studies were eligible for inclusion in this scoping review. Seven papers identified the factors contributing to waiting time, and five papers mentioned effective interventions implemented to reduce waiting times within PHC facilities. Our analysis produced three (patient factors, staff factors, and administrative systems) and two (manual-based waiting time reduction systems and electronic-based waiting time reduction systems) main themes pertaining to factors contributing to long waiting times and interventions to reduce waiting times, respectively.

CONCLUSION

Our results revealed that the patients, staff, and administrative systems all contribute to long waiting times within the PHC facilities. Patient waiting times recorded a wider and more evenly spread patient arrival pattern after the identified interventions in our study were implemented. There is a need to constantly strategize on measures such as implementing the use of an electronic appointment scheduling system and database, improving staff training on efficient patient flow management, and regularly assessing and optimizing administrative processes. By continuously monitoring and adapting these strategies, PHC facility managers can create a more efficient and patient-centered healthcare experience.

Process reengineering using DMAIC framework for reduction of waiting time in daycare infusion therapy for better patient experience

Daycare infusion therapy is an integral aspect of oncology, but increased waiting time raises concerns for patients. Patient-reported experience measures prompted the need to evaluate reasons for prolonged appointment delays. This study seeks to analyze and address patients' concerns, to streamline the process flow and reduce waiting time for daycare infusion therapy thereby enhancing patient experience. The define, measure, analyze, improve, and control methodology was implemented, and its impact on reducing waiting times was evaluated. The objective is to ensure that >85% of patients enter the daycare infusion unit within an hour of their appointment time in 6 months. The baseline data for patient waiting times was measured for a period of 2 months, and the average waiting time was determined. Potential causes contributing to prolonged waiting times were identified through time-motion analysis, with a fishbone diagram categorizing potential causes and a Pareto chart prioritizing them. Plan, do, study, and act cycles were conducted for implementing the changes, and a new process flow mapped. Baseline data showed 32% average adherence to the defined turnaround time of 1 hour, with an average waiting time of 108 minutes. Forty causes were identified for increased waiting time, of which eight were key. Adherence to waiting time turnaround time improved from 32% to 89% and the average waiting time decreased by 59 minutes from 108 minutes, increasing patient satisfaction index by 7.5%. The balancing measures include an increase in operational efficiency and throughput of the unit and the inventory levels of oncology medicine were decreased, leading to a 50% reduction in inventory value, while medication error declined by 0.62%, improving patient safety. The project gained tangible and intangible benefits impacting staff, patients, and relatives while improving operational efficiency. This study, with its scientific and systematic approach, enhanced patient satisfaction, patient safety, and better utilization of resources.

Inequalities in unmet health care needs under universal health insurance coverage in China

BACKGROUND

Expanding health insurance is a critical step towards universal health coverage due to its positive effect on reducing unmet health care needs and enhancing equitable access to health care. Despite previous studies on the socioeconomic factors associated with unmet health care needs, few studies have analysed the inequalities in such needs and the impact of universal health insurance coverage on addressing them. This study aimed to measure the contribution of social health insurance (SHI) coverage to inequalities in financially and non-financially constrained unmet health care needs among middle-aged and elderly Chinese adults.

METHODS

The study data were obtained from the China Health and Retirement Longitudinal Study (2011-2015). A total of 11,592 respondents reporting outpatient care needs and 6320 reporting inpatient care needs were included. The concentration index (CI) was employed to measure the extent of income-related inequalities in unmet health care needs. A decomposition method based on a probit model was used to investigate the contribution of SHI to the inequalities.

RESULTS

The incidence rates of unmet outpatient needs due to financial and non-financial constraints were 4.68% and 24.78%, respectively; these rates were 18.69% and 15.73% for unmet inpatient needs. The CIs of unmet outpatient needs due to financial and non-financial constraints were - 0.1872 and 0.0195, respectively; these values were - 0.1558 and 0.0352 for unmet inpatient needs. The percentages of the contribution of SHI to the CIs of financially constrained unmet outpatient and inpatient needs were 0.2639% and 1.8898%, respectively. Moreover, the percentages of the contribution of SHI to the CIs of non-financially constrained unmet outpatient and inpatient needs were - 0.4513% and - 6.4192%, respectively.

CONCLUSION

The universal coverage of SHI in China increased pro-poor inequalities in financially constrained unmet health care needs but decreased pro-rich inequalities in non-financially constrained unmet needs. Additionally, the contribution of SHI to inequalities in financially constrained unmet needs for inpatient care was stronger than that for outpatient care. Policy-makers are advised to introduce favourable reimbursement policies for patients with poor socioeconomic conditions and address both financial and non-financial barriers to promote equitable access to health care for the entire population.

Analysis of factors affecting ultrasound examination time: A quantitative study

BACKGROUND

Numerous studies have focused on reducing patient absences and effectively scheduling exams. However, very few studies have analyzed the factors influencing examination time and predicted examination time.

OBJECTIVES

To investigate the factors affecting ultrasound examination visit length and provide a reference for interventions to optimize ultrasound appointments.

METHODS

This cross-sectional study was conducted at a fertility clinic in China. Ultrasound examination time and clinical characteristics were obtained from the electronic records. Univariate and multivariate analyses used 33,432 patients who attended our clinic center between August 1 and October 30, 2018. A quantile regression model was constructed to examine associations between ultrasound examination time and statistically significant variables in the univariate analysis.

RESULTS

Of the 33,432 patients included in this study, 29,085 (87%) were female and 4,347 (13%) were male. Their mean examination time was 6 ± 3 minutes. The doctor's title and gender, equipment, and patient's age, examination site, gender, and origin were all statistically significant. Physical examination and outpatient clinic patients had shorter examination times than inpatients. Female physicians had longer examination times than male physicians. Examination time was positively correlated with thyroid, breast, liver, gallbladder, spleen, pancreas, kidney, heart, vascular, adrenal, gynecological, early pregnancy, nuchal translucency, prostate, scrotum, and mid-to-late pregnancy fetal sites. Moreover, NT and mid-to-late pregnancy fetal sites showed a clear and continuous positive trend with increasing examination time.

CONCLUSION

The length of the ultrasound examination was correlated with the examination site, physician title, physician gender, patient age, patient gender, patient origin, and instrumentation. The reliability of inspection time predicted by variables such as the physicians' title, sex, sites examined, and the number of sites examined was higher when they were longer.

Propensity Score Matching Analysis of the Influence of Waiting Time Satisfaction on Community Resident's Satisfaction With Medical Institutions: An Extensive Survey of Outpatient Population in Shantou City of Southern China

OBJECTIVE

This study was designed to perform a nuanced analysis of the multifaceted association between community residents' satisfaction and their perceived satisfaction concerning the visit duration at medical facilities, that could be harnessed to enhance and streamline the process of hierarchical diagnosis and treatment, thereby augmenting healthcare outcomes and patient experiences.

METHODS

Respondents who had utilized services from medical institutions were invited to fill out questionnaires by scanning QR codes. Additionally, surveys also distributed questionnaires through WeChat groups of community residents in densely populated areas of the community, as well as WeChat groups for patients who had previously visited local hospitals. To balance differences between groups, propensity score matching was applied to analyze the contrast between residents satisfied and dissatisfied with their medical visits. After eliminating the interference of confounding factors, a comparative analysis was conducted on the relationship between resident satisfaction and medical institution experience.After eliminating the interference of confounding factors, a comparative analysis was conducted to delve deeply into the relationship between residents' satisfaction and their experiences at medical facilities.

RESULTS

The study incorporated a large dataset encompassing 2356 community residents. Upon successful propensity score matching, logistic regression analysis elucidated several determinants of overall resident satisfaction. Notably, the grade of the medical institution (χ2 = 8.226, P < .05), satisfaction with the time invested in the registration process (χ2 = 11.04, P < .05), satisfaction with the waiting duration for consultation (χ2 = 15.759, P < .05), and satisfaction with the travel time to the hospital (χ2 = 45.157, P < .05) each exerted significant influence on the holistic satisfaction of residents with their medical experience.

CONCLUSION

Factors such as the grade of the medical institution, satisfaction related to registration and waiting durations, and travel time to the hospital emerged as crucial determinants shaping community residents' holistic satisfaction with their medical encounters. These findings underscore the exigency for strategic allocation and optimization of medical resources, refinement of the classification system, and enhancement of public health education on the graded diagnosis and treatment schema. The study also demonstrates the value of employing advanced propensity score matching and predictive modelling techniques in health services research.

Utilization of Proximate Healthcare Facilities and Children's Wait Times in Senegal: An IV-Tobit Analysis

Universal health coverage (UHC) defines individuals' timely access to healthcare services without suffering any health-related financial constraints. The Senegalese government has shown commitments towards achievement of UHC as a way of improving access by the population to quality healthcare services. This is very pertinent for promoting some indicators of under-five health in Senegal. Therefore, this study analyzed the factors influencing sick children's utilization of the nearest healthcare facilities and their wait times in Senegal. The data were from the Service Provision Assessment (SPA) survey, which was conducted in 2018. The instrumental Tobit regression model was used for data analysis. The results showed that 63.50% and 86.01% of the children utilized health posts and publicly owned facilities, respectively. Also, 98.46% of the children utilized urban facilities. The nearest facilities were utilized by 74.55%, and 78.19% spent less than an hour in the facilities. The likelihood of using the nearest healthcare facilities significantly reduced (p < 0.05) with caregivers' primary education, higher education, residence in some regions (Fatick, Kaokack, Saint Louis, Sediou, and Tambacounda), and use of private/NGO not-for-profit facilities, but increased with not having visited any other providers, residence in the Kaffrie region, vomiting symptoms, use of health centers, and use of health posts. Moreover, treatment wait times significantly increased (p < 0.05) with the use of nearest facilities, residence in some regions (Diourbel, Kaokack, Matam and Saint Louis), use of private for-profit facilities, use of private not-for-profit facilities, and urban residence, but decreased with secondary education, use of health centers, use of health posts, vomiting symptoms, and showing other symptoms. It was concluded that reduction in wait times and utilization of the nearest healthcare facilities are fundamental to achieving UHC in Senegal. Therefore, more efforts should be integrated at promoting regional and sectoral equities through facilitated public and private healthcare investment.

Analyzing and Forecasting Pediatric Fever Clinic Visits in High Frequency Using Ensemble Time-Series Methods After the COVID-19 Pandemic in Hangzhou, China: Retrospective Study

BACKGROUND

The COVID-19 pandemic has significantly altered the global health and medical landscape. In response to the outbreak, Chinese hospitals have established 24-hour fever clinics to serve patients with COVID-19. The emergence of these clinics and the impact of successive epidemics have led to a surge in visits, placing pressure on hospital resource allocation and scheduling. Therefore, accurate prediction of outpatient visits is essential for informed decision-making in hospital management.

OBJECTIVE

Hourly visits to fever clinics can be characterized as a long-sequence time series in high frequency, which also exhibits distinct patterns due to the particularity of pediatric treatment behavior in an epidemic context. This study aimed to build models to forecast fever clinic visit with outstanding prediction accuracy and robust generalization in forecast horizons. In addition, this study hopes to provide a research paradigm for time-series forecasting problems, which involves an exploratory analysis revealing data patterns before model development.

METHODS

An exploratory analysis, including graphical analysis, autocorrelation analysis, and seasonal-trend decomposition, was conducted to reveal the seasonality and structural patterns of the retrospective fever clinic visit data. The data were found to exhibit multiseasonality and nonlinearity. On the basis of these results, an ensemble of time-series analysis methods, including individual models and their combinations, was validated on the data set. Root mean square error and mean absolute error were used as accuracy metrics, with the cross-validation of rolling forecasting origin conducted across different forecast horizons.

RESULTS

Hybrid models generally outperformed individual models across most forecast horizons. A novel model combination, the hybrid neural network autoregressive (NNAR)-seasonal and trend decomposition using Loess forecasting (STLF), was identified as the optimal model for our forecasting task, with the best performance in all accuracy metrics (root mean square error=20.1, mean absolute error=14.3) for the 15-days-ahead forecasts and an overall advantage for forecast horizons that were 1 to 30 days ahead.

CONCLUSIONS

Although forecast accuracy tends to decline with an increasing forecast horizon, the hybrid NNAR-STLF model is applicable for short-, medium-, and long-term forecasts owing to its ability to fit multiseasonality (captured by the STLF component) and nonlinearity (captured by the NNAR component). The model identified in this study is also applicable to hospitals in other regions with similar epidemic outpatient configurations or forecasting tasks whose data conform to long-sequence time series in high frequency exhibiting multiseasonal and nonlinear patterns. However, as external variables and disruptive events were not accounted for, the model performance declined slightly following changes in the COVID-19 containment policy in China. Future work may seek to improve accuracy by incorporating external variables that characterize moving events or other factors as well as by adding data from different organizations to enhance algorithm generalization.

Successes and challenges towards improving quality of primary health care services: a scoping review

BACKGROUND

Quality health services build communities' and patients' trust in health care. It enhances the acceptability of services and increases health service coverage. Quality primary health care is imperative for universal health coverage through expanding health institutions and increasing skilled health professionals to deliver services near to people. Evidence on the quality of health system inputs, interactions between health personnel and clients, and outcomes of health care interventions is necessary. This review summarised indicators, successes, and challenges of the quality of primary health care services.

METHODS

We used the preferred reporting items for systematic reviews and meta-analysis extensions for scoping reviews to guide the article selection process. A systematic search of literature from PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), Scopus, and Google Scholar was conducted on August 23, 2022, but the preliminary search was begun on July 5, 2022. The Donabedian's quality of care framework, consisting of structure, process and outcomes, was used to operationalise and synthesise the findings on the quality of primary health care.

RESULTS

Human resources for health, law and policy, infrastructure and facilities, and resources were the common structure indicators. Diagnosis (health assessment and/or laboratory tests) and management (health information, education, and treatment) procedures were the process indicators. Clinical outcomes (cure, mortality, treatment completion), behaviour change, and satisfaction were the common indicators of outcome. Lower cause-specific mortality and a lower rate of hospitalisation in high-income countries were successes, while high mortality due to tuberculosis and the geographical disparity in quality care were challenges in developing countries. There also exist challenges in developed countries (e.g., poor quality mental health care due to a high admission rate). Shortage of health workers was a challenge both in developed and developing countries.

CONCLUSIONS

Quality of care indicators varied according to the health care problems, which resulted in a disparity in the successes and challenges across countries around the world. Initiatives to improve the quality of primary health care services should ensure the availability of adequate health care providers, equipped health care facilities, appropriate financing mechanisms, enhance compliance with health policy and laws, as well as community and client participation. Additionally, each country should be proactive in monitoring and evaluation of performance indicators in each dimension (structure, process, and outcome) of quality of primary health care services.

Experiences of patients on cancer treatment regarding decentralization of oncology services at a tertiary hospital in the Eastern Cape

BACKGROUND

The cancer burden is a global public health concern associated with high morbidities and mortalities. Low and middle-income countries are more affected including South Africa. Limited access to oncology services contributes to the late presentation, late diagnosis, and treatment of cancer. In the Eastern Cape, oncology services were previously centralized with negative effects on the quality of life of the already compromised health status of the oncology patients. To mitigate the situation, a new oncology unit was opened to decentralize oncology services in the province. Little is known about the experiences of patients after this transformation. That prompted this inquiry.

AIM

This study aims to explore the experiences of cancer patients regarding the decentralization of oncology services at a tertiary hospital in the Eastern Cape.

METHODOLOGY

A qualitative approach with a descriptive, explorative, and contextual design was undertaken, to obtain the perspective of oncology recipients following the decentralization of oncology services at a selected public tertiary hospital in the Eastern Cape. After obtaining ethical clearance and permission to conduct the study, interviews were conducted with 19 participants. All interviews were transcribed verbatim against their audio recordings. Field notes were taken by the primary researcher. The concept of trustworthiness was used to ensure rigour throughout this study. Thematic analysis was done using Tesch's approach to open coding in qualitative research.

RESULTS

Three themes emerged from the data analysis: 1) Access to oncology services; 2) Oncology services provided; and 3) Need for improved infrastructural facilities.

CONCLUSION

The majority of patients had positive experiences with the unit. The waiting time was acceptable, and medication was available. Access to services was improved. The staff had a positive attitude towards patients receiving cancer treatment.

How to adjust the expected waiting time to improve patient's satisfaction?

BACKGROUND

Long waiting time in hospital leads to patient's low satisfaction. In addition to reducing the actual waiting time (AWT), we can also improve satisfaction by adjusting the expected waiting time (EWT). Then how much can the EWT be adjusted to attribute a higher satisfaction?

METHODS

This study was conducted though experimental with hypothetical scenarios. A total of 303 patients who were treated by the same doctor from August 2021 to April 2022 voluntarily participated in this study. The patients were randomly divided into six groups: a control group (n = 52) and five experimental groups (n = 245). In the control group, the patients were asked their satisfaction degree regarding a communicated EWT (T₀) and AWT (T_a) under a hypothetical situation. In the experimental groups, in addition to the same T₀ and T_a as the control group, the patients were also asked about their satisfaction degree with the extended communicated EWT (T₁). Patients in five experimental groups were given T₁ values with 70, 80, 90, 100, and 110 min respectively. Patients in both control and experiment groups were asked to indicate their initial EWT, after given unfavorable information (UI) in a hypothetical situation, the experiment groups were asked to indicate their extended EWT. Each participant only participated in filling out one hypothetical scenario. 297 valid hypothetical scenarios were obtained from the 303 hypothetical scenarios given.

RESULTS

The experimental groups had significant differences between the initial indicated EWT and extended indicated EWT under the effect of UI (20 [10, 30] vs. 30 [10, 50], Z = -4.086, P < 0.001). There was no significant difference in gender, age, education level and hospital visit history (χ² = 3.198, P = 0.270; χ² = 2.177, P = 0.903; χ² = 3.988, P = 0.678; χ² = 3.979, P = 0.264) in extended indicated EWT. As for patient's satisfaction, compared with the control group, significant differences were found when T₁ = 80 min (χ² = 13.511, P = 0.004), T₁ = 90 min (χ² = 12.207, P = 0.007) and T₁ = 100 min (χ² = 12.941, P = 0.005). When T₁ = 90 min, which is equal to the T_a, 69.4% (34/49) of the patients felt "very satisfied", this proportion is not only significantly higher than that of the control group (34/ 49 vs. 19/52, χ² = 10.916, P = 0.001), but also the highest among all groups. When T₁ = 100 min (10 min longer than T_a), 62.5% (30/48) of the patients felt "very satisfied", it is significantly higher than that of the control group (30/ 48 vs. 19/52, χ² = 6.732, P = 0.009). When T₁ = 80 min (10 min shorter than T_a), 64.8% (35/54) of the patients felt "satisfied", it is significantly higher than that of the control group (35/ 54 vs. 17/52, χ² = 10.938, P = 0.001). However, no significant difference was found when T₁ = 70 min (χ² = 7.747, P = 0.052) and T₁ = 110 min (χ² = 4.382, P = 0.223).

CONCLUSIONS

Providing UI prompts can extend the EWT. When the extended EWT is closer to the AWT, the patient's satisfaction level can be improved higher. Therefore, medical institutions can adjust the EWT of patient's through UI release according to the AWT of hospitals to improve patient's satisfaction.

Learning from pandemic responses: Informing a resilient and equitable health system recovery in Thailand

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The third quarter of 2022 saw COVID-19 cases and deaths in Thailand reduced significantly, and high levels of COVID-19 vaccine coverage. COVID-19 was declared an "endemic" disease, and economic activities resumed. This paper reviews pre-pandemic health systems capacity and identifies pandemic response strengths, weaknesses and lessons that guided resilient and equitable health system recovery. Robust health systems and adaptive strategies drive an effective pandemic response. To support health system recovery Thailand should (1) minimize vulnerability and extend universal health coverage to include migrant workers and dependents; (2) sustain provincial primary healthcare (PHC) capacity and strengthen PHC in greater Bangkok; (3) leverage information technology for telemedicine and teleconsultation; (4) enhance and extend case and event-based surveillance of notifiable diseases, and for public health threats, including pathogens with pandemic potential in wildlife and domesticated animals. This requires policy and financial commitment across successive governments, adequate numbers of committed and competent health workforce at all levels supported by over a million village health volunteers, strong social capital and community resilience. A strengthened global health architecture and international collaboration also have critical roles in establishing local capacities to develop and manufacture pandemic response products through transfer of technology and know-how. Countries should engage in the ongoing Inter-government Negotiating Body to ensure a legally binding instrument to safeguard the world from catastrophic impacts of future pandemics.

Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care

BACKGROUND

Postnatal care (PNC) is an important set of services offered to the mother and her newborn baby immediately after birth for the first six weeks to prevent maternal and neonatal complications and death. This qualitative study explored user and provider perspectives on quality of PNC services in the selected health facilities within the context of the Maternity Homes Access in Zambia project in the Saving Mothers Giving Life districts in rural Zambia.

METHODS

Between October 2018 and February 2019, forty focus group discussions (FGDs) (n = 160 participants) and twelve in-depth interviews (IDIs) were conducted in four districts in Southern and Eastern provinces. FGDs comprised women who delivered within the last year, fathers, community elders, and volunteers. IDIs comprised health workers at facility, district, and provincial levels. Data were analysed using content analysis guided by the international quality of care domains derived from the World Health Organization quality of care framework. Findings were triangulated to understand perceptions.

RESULTS

Overall, study participants perceived PNC services to be beneficial. Nevertheless, respondents had mixed feelings on the quality of PNC services and expressed a stark difference in their perception of factors affecting service quality. Service users described challenges arising from ineffective communication about the new PNC guidelines, and non-adherence of service providers to quality standards regarding respect, preservation of dignity and emotional support. Other factors were long waiting hours, small examination rooms providing inadequate privacy, and low levels of confidentiality. In contrast, service providers attributed poor service quality to various health system-related factors including low staffing levels, dysfunctional referral services, low supply of essential medicines, supplies, vaccines and equipment for optimal routine emergency obstetric and newborn care and management of complications.

CONCLUSION

These findings highlight important intervention opportunities to improve quality of PNC services in Zambia through better communication and raising awareness on PNC guidelines, respect, preservation of dignity and emotional support to mothers. Interventions should also focus on addressing contextual health system challenges including staffing levels, supply chain for essential medicines and commodities, shortening waiting time, and ensuring functional referral system.

Managing Outpatient Cycle Times in Hospitals Using Integrated Closed-Loop Approaches

Long waiting times in outpatient clinics have multiple adverse effects on patients and their attendants, staff and hospital management. Several approaches practiced to manage the cycle time have been proposed. The purpose of this study was to evaluate the impact of implementing closed-loop based multiple approaches together. This study was conducted in Aravind Eye Hospital (AEH), Madurai, India where several approaches to manage cycle times have been implemented over the years. Scheduling system was introduced to manage COVID-19 specific norms. We compared the cycle times in general outpatient clinics in a regime in which multiple approaches were practiced together before and after introducing scheduling to regimes in which individual approaches were practiced. We analysed how the cycle time varied by patient load. Cycle time for all patient days when the combined approach was used was 19% lower than baseline, and better than under each of the individual approaches. The outcome sustained even during the COVID-19 pandemic that necessitated additional processes and procedures. Therefore, implementing multiple approaches can be more effective to reduce the cycle time than implementing individual approaches.

Hospital crowdedness evaluation and in-hospital resource allocation based on image recognition technology

How to allocate the existing medical resources reasonably, alleviate hospital congestion and improve the patient experience are problems faced by all hospitals. At present, the combination of artificial intelligence and the medical field is mainly in the field of disease diagnosis, but lacks successful application in medical management. We distinguish each area of the emergency department by the division of medical links. In the spatial dimension, in this study, the waitlist number in real-time is got by processing videos using image recognition via a convolutional neural network. The congestion rate based on psychology and architecture is defined for measuring crowdedness. In the time dimension, diagnosis time and time-consuming after diagnosis are calculated from visit records. Factors related to congestion are analyzed. A total of 4717 visit records from the emergency department and 1130 videos from five areas are collected in the study. Of these, the waiting list of the pediatric waiting area is the largest, including 10,436 (person-time) people, and its average congestion rate is 2.75, which is the highest in all areas. The utilization rate of pharmacy is low, with an average of only 3.8 people using it at the one time. Its average congestion rate is only 0.16, and there is obvious space waste. It has been found that the length of diagnosis time and the length of time after diagnosis are related to age, the number of diagnoses and disease type. The most common disease type comes from respiratory problems, accounting for 54.3%. This emergency department has congestion and waste of medical resources. People can use artificial intelligence to investigate the congestion in hospitals effectively. Using artificial intelligence methods and traditional statistics methods can lead to better research on healthcare resource allocation issues in hospitals.

Impact of Socio-demographic Characteristics on Time in Outpatient Cardiology Clinics: A Retrospective Analysis

Inequitable access to health services influences health outcomes. Some studies have found patients of lower socio-economic status (SES) wait longer for surgery, but little data exist on access to outpatient services. This study analyzed patient-level data from outpatient public cardiology clinics and assessed whether low SES patients spend longer accessing ambulatory services. Retrospective analysis of cardiology clinic encounters across 3 public hospitals between 2014 and 2019 was undertaken. Data were linked to age, gender, Indigenous status, country of birth, language spoken at home, number of comorbidities, and postcode. A cox proportional hazards model was applied adjusting for visit type (new/follow up), clinic, and referral source. Higher hazard ratio (HR) indicates shorter clinic time. Overall, 22 367 patients were included (mean [SD] age 61.4 [15.2], 14 925 (66.7%) male). Only 7823 (35.0%) were born in Australia and 8452 (37.8%) were in the lowest SES quintile. Median total clinic time was 84 min (IQR 58-130). Visit type, clinic, and referral source were associated with clinic time (R² = 0.23, 0.35, 0.20). After adjusting for these variables, older patients spent longer in clinic (HR 0.94 [0.90-0.97]), though there was no difference according to SES (HR 1.02 [0.99-1.06]) or other variables of interest. Time spent attending an outpatient clinic is substantial, amplifying an already significant time burden faced by patients with chronic health conditions. SES was not associated with longer clinic time in our analysis. Time spent in clinics could be used more productively to optimize care, improve health outcomes and patient experience.

General population preferences for cancer care in health systems of China: A discrete choice experiment

BACKGROUND

The increasing incidence of cancer in China has posed considerable challenges for cancer care delivery systems. This study aimed to determine the general population's preferences for cancer care, to provide evidence for building a people-centered integrated cancer care system.

METHODS

We conducted a discrete choice experiment that involved 1,200 participants in Shandong Province. Individuals were asked to choose between cancer care scenarios based on the type and level of hospitals, with various out-of-pocket costs, waiting time, and contact working in the hospitals. Individual preferences, willingness to pay, and uptake rate were estimated using a mixed-logit model.

RESULTS

This study included 848 respondents (70.67%). Respondents preferred county hospitals with shorter hospitalization waiting times and contact working in hospitals. Compared to the reference levels, the three highest willingness to pay values were related to waiting time for hospitalization (¥97,857.69-¥145411.70-¥212,992.10/$14512.70-$21565.16-$31587.61), followed by the county-level hospital (¥32,545.13/$4826.58). The preferences of the different groups of respondents were diverse. Based on a county-level general hospital with contact in the hospital, 50% out-of-pocket costs and a waiting time of 15 days, the probability of seeking baseline care was 0.37. Reducing the waiting time from 15 to 7, 3, and 0 days, increases the probability of choosing a county-level hospital from 0.37 to 0.58, 0.64, and 0.70, respectively.

CONCLUSIONS

This study suggests that there is a substantial interest in attending county-level hospitals and that reducing hospitalization waiting time is the most effective measure to increase the probability of seeking cancer care in county-level hospitals.

Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study

Background

Consultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services.

Methods

We defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider’s responses, total words of provider’s all responses, and average words of provider’s each response. We appraised E-consults services quality using five indicators building on China’s clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality.

Results

Providers who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well.

Conclusions

The times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08566-2.

The effectiveness of a pain management programme on pain control and quality of life in patients with metastatic cancer

BACKGROUND

Pain is one of the most frequent symptoms in cancer patients and has a negative impact on their physical, emotional and functional status, as well as their quality of life (QOL). This study evaluated the effectiveness of a pain management programme on pain control and QOL among patients with metastatic cancer receiving systemic chemotherapy. The authors investigated whether a pain management programme contributes to a better pain control and improvement in QOL in the outpatient setting.

METHODS

The authors conducted a randomised, single-blinded, controlled, single-centre study of metastatic cancer patients experiencing cancer pain and requiring opioid therapy. Patients were enrolled from the Medical Oncology Outpatient Clinic, Songklanagarind Hospital, Prince of Songkla University, Thailand. Participants were randomly assigned to two strategies: pain assessment and management based on the programme developed by the researchers ('pain management programme' arm), and pain management by individual medical oncologists per the routine procedure ('standard of care' arm). Demographics questionnaires, a pain intensity assessment using the Numeric Rating Scale (NRS) and the Functional Assessment of Cancer Therapy-General (FACT-G, version 4) were used to assess the QOL and cancer pain severity at baseline and at two follow-up visits.

RESULTS

Between November 2016 and July 2017, 64 consecutive patients were randomly assigned to the two treatment groups. Most were male (79.7%), with a mean age of 55.1 (±13.8) years. The majority of patients (23; 35.9%) had squamous cell carcinoma of the head and neck, with other prevalent types being lung cancer (9.4%), esophageal cancer (9.4%) and colorectal cancer (9.4%). The most frequent metastatic sites were the lungs (28.1%), liver (26.6%), and bone (20.3%).

FINDINGS

Compared with standard care, pain intensity was significantly lower among the patients receiving the pain management programme: 4.0 ±2.2 versus 5.1 ±1.8 (P = 0.033) and 3.3 ±1.7 versus 4.7 ±2.1 (P = 0.025) at visit 1 and 2, respectively. Likewise, QOL measures scored higher in the pain management programme group: 71.2 ±15.4 versus 58.6 ±14.5 (P = 0.002) and 71.8 ±15.5 versus 55.4 ±16.3 (P = 0.002) at visit 1 and 2, respectively. Furthermore, there was a statistically significant positive correlation between pain control and QOL improvement (P = 0.011).

CONCLUSION

The investigated pain management programme significantly improved both pain control and QOL in metastatic cancer patients receiving systemic chemotherapy in the outpatient setting.

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

BACKGROUND

Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles.

OBJECTIVE

The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction.

METHODS

This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time.

RESULTS

In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92).

CONCLUSIONS

Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.

The Association between mHealth App Use and Healthcare Satisfaction among Clients at Outpatient Clinics: A Cross-Sectional Study in Inner Mongolia, China

Mobile health (mHealth) applications (apps) have been developed in hospital settings to allocate and manage medical care services, which is one of the national strategies to improve health care in China. Little is known about the comprehensive effects of hospital-based mHealth app use on client satisfaction. The aim of this study was to determine the relationship between the full range of mHealth app use and satisfaction domains among clients attending outpatient clinics. A cross-sectional survey was conducted from January to February 2021 in twelve tertiary hospitals in Inner Mongolia. After the construction of the mHealth app use, structural equation modeling was used for data analysis. Of 1889 participants, the standardized coefficients β on environment/convenience, health information, and medical service fees were 0.11 (p < 0.001), 0.06 (p = 0.039), and 0.08 (p = 0.004), respectively. However, app use was not significantly associated with satisfaction of doctor−patient communication (β = 0.05, p = 0.069), short-term outcomes (β = 0.05, p = 0.054), and general satisfaction (β = 0.02, p = 0.429). Clients of the study hospitals were satisfied with the services, but their satisfaction was not much associated with mHealth use. The limitation of the mHealth system should be improved to enhance communication and engagement among clients, doctors, and healthcare givers, as well as to pay more attention to health outcomes and satisfaction of clients.

Physician-Customized Strategies for Reducing Outpatient Waiting Time in South Korea Using Queueing Theory and Probabilistic Metamodels

The time a patient spends waiting to be seen by a healthcare professional is an important determinant of patient satisfaction in outpatient care. Hence, it is crucial to identify parameters that affect the waiting time and optimize it accordingly. First, statistical analysis was used to validate the effective parameters. However, no parameters were found to have significant effects with respect to the entire outpatient department or to each department. Therefore, we studied the improvement of patient waiting times by analyzing and optimizing effective parameters for each physician. Queueing theory was used to calculate the probability that patients would wait for more than 30 min for a consultation session. Using this result, we built metamodels for each physician, formulated an effective method to optimize the problem, and found a solution to minimize waiting time using a non-dominated sorting genetic algorithm (NSGA-II). On average, we obtained a 30% decrease in the probability that patients would wait for a long period. This study shows the importance of customized improvement strategies for each physician.

Socio-demographic digital divide in mHealth app use among clients at outpatient departments in Inner Mongolia, China: a cross-sectional study (Preprint)

Background

Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital divide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers.

Objective

The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade.

Methods

A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated.

Results

Of 2115 participants, the β coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (β=–0.38 and β=–0.41), as were less educated subgroups (β=–0.24 and β=–0.27), and these two factors had nonsignificant direct effects on mHealth use.

Conclusions

To overcome the mHealth use divide, it is important to improve digital access and digital use among older adults and less educated groups.

The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study

Background

To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic.

Objective

The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses’ time required for screening and the waiting time for patients to receive medical care.

Methods

This was a single-center, comparative, prospective study designed according to the Public Health England guide “Evaluating Digital Products for Health.” A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution.

Results

The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours.

Conclusions

The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic.

Factors affecting waiting time in Outpatient Pharmacy at Hospital Raja Perempuan Zainab II (HRPZ II)

Introduction: World Health Organization (WHO) has identified that patient waiting time as one of the most important measurements of a responsive health system for healthcare services. Outpatient pharmacy is associated with patient waiting time as the indicator for satisfaction of the services. This study aimed to determine the factors affecting waiting time in Hospital Raja Perempuan Zainab II, Kelantan. Materials and method: A cross sectional study was conducted by collecting prescription received in outpatient pharmacy from 1st October 2020 till 31st December 2020. All prescriptions prescribed manually were excluded. Multiple linear regression was performed to determine the factors affecting waiting time and the data were analysed using SPSS version 25. Results: A total of 248 prescriptions were collected in outpatient pharmacy. The mean waiting time in outpatient pharmacy was 23.0 minutes (SD = 11.0). Waiting time was found to be associated with number of medications in the prescription, number of staff working on that day, prescriptions which required intervention and filling personnel. Conclusion: The waiting time at the outpatient pharmacy of HRPZ II indicated the acceptable range of quality services which met the patient’s satisfaction. Future studies are needed to confirm the satisfaction level of patients and further improve quality of the service.

Applying Discrete Event Simulation to Reduce Patient Wait Times and Crowding: The Case of a Specialist Outpatient Clinic with Dual Practice System

Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital’s information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study’s dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10–21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.

Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

OBJECTIVES

Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.

DESIGN

We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients' preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.

SETTING

The DCE was conducted in Jiangsu province and Shanghai municipality in China.

PARTICIPANTS

Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.

RESULTS

Patients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician-patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients' choice (β=-0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.

CONCLUSIONS

Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients' preferences.

Satisfaction among patients and caregivers receiving value-added services during the COVID-19 pandemic outbreak in a tertiary hospital in the Perak state of Malaysia

Objectives

Patient satisfaction was used as an indicator of service quality in the public hospitals. The pharmacy value-added services (VAS) were intensified after the COVID-19 outbreak, and evaluation of user’s satisfaction was important for service improvement.

Methods

This was a single-centre, cross-sectional, web-based study in the outpatient pharmacy in a tertiary hospital in the Perak state of Malaysia. Patients and caregivers aged 18 years and above, received at least one prescription refill using the pharmacy VAS from April to September 2020, were included. The questionnaire was adapted from a validated tool, underwent face and content validation before dissemination. The link was disseminated to the targeted population through short messages service (SMS).

Key findings

Out of 1200 invited people, 303 agreed to participate. Majority of the respondents were male (160, 52.8%), Chinese (156, 51.5%), with tertiary education (201, 66.3%) and retiree (112, 37.0%). Out of a maximum score of 5, the overall mean satisfaction score was 4.42 (SD: 0.55). The respondents were most agreeable to time-saving benefits of the pharmacy VAS (4.56 ± 0.63). Majority of the respondents felt that pharmacy VAS had made their life easier (290, 95.7%) and planned to recommend the pharmacy VAS to others (292, 96.4%) Respondents aged more than 60 (versus age 18–35, β = 2.375, P &lt; 0.001) and those who used drive-through service (versus SPUB, β = 2.272, P = 0.001) reported higher satisfaction scores. Several suggestions were made for service improvement, including longer operating hours (18, 6.0%), upgraded communication system (9, 3.0%), smoother registration process (9, 3.0%), more polite staff (9, 3.0%), selection of preferred postage delivery time (6, 2.0%) and promotion of VAS (4, 1.3%)

Conclusions

Majority of the respondents were highly satisfied towards the pharmacy VAS. Future studies should compare the satisfaction of VAS with traditional counter service to compare the level and factors that contributed to the users’ satisfaction.

Psychometric Evaluation of the Chinese Version of Hypertension Self-care Profile

BACKGROUND

Valid and reliable assessment of the multidimensional self-care of patients with hypertension is important to tailor individualized care. The Hypertension Self-care Profile (HBP SCP), which comprises behavior, motivation, and self-efficacy scales, has been widely tested in various settings.

OBJECTIVE

The aims of this study were to translate the HBP SCP into a Chinese version (HBP SCP-C) and evaluate its psychometric properties among Chinese adults with hypertension.

METHODS

The HBP SCP was translated to Chinese using Cha's combined translation technique, and its content validity was examined by a panel of 7 experts. The psychometric properties of HBP SCP-C were tested in 200 Chinese patients with hypertension. Reliability tests included internal consistency and test-retest reliability. Exploratory factor analysis was performed to explore the structure of HBP SCP-C. Discriminative validity was examined by the known-group approach.

RESULTS

The HBP SCP-C demonstrated satisfactory content validity. The 2-factor structures of the behavior ("health promotion" and "habit modification") and self-efficacy ("intake management" and "health maintenance") scales and 1-factor structure of the motivation scale were determined. The behavior, motivation, and self-efficacy scales had Cronbach α coefficients of 0.86, 0.94, and 0.93, respectively, and test-retest reliabilities were 0.82 to 0.98, 0.90 to 0.98, and 0.81 to 0.95, respectively. Significant differences between patients with or without comorbidities in behavior (t = 2.55, P = .011), motivation (t = 3.25, P = .001), and self-efficacy (t = 3.02, P = .003) supported the discriminative validity of HBP SCP-C.

CONCLUSIONS

The HBP SCP-C could be a reliable and valid instrument for evaluating hypertension self-care in Chinese patients.

Reduce Patient Treatment wait time in a Proton Beam Facility - A Gatekeeper Approach

Patient wait time can negatively impact treatment quality in a proton therapy center, where multiple treatment rooms share one proton beam. Wait time increases patient discomfort that can lead to patient motion, dissatisfaction, and longer treatment delay. This study was to develop a patient call-back model that reduced patient wait while efficiently utilizing the proton beam. A "Gatekeeper" logic allowing therapists to adjust the time of a patient's call-back to the treatment room was developed. It uses a two-pronged approach to minimize overlap of long treatment and the possibility of excessive wait in the queue to receive the proton beam. The goal was to reduce the maximum wait time to less than eight minutes per field for a four-room facility. The effectiveness of this logic was evaluated through simulation, and five scenarios were compared. Four scenarios implementing various levels of gatekeeper logic were compared with the original scenario without the logic. The best performing model provided a reduction of the maximum field wait by 26% and met the predefined goal. Adjusting call-back extended the treatment day length by an average of 6 min and a maximum of 12 min in total. The use of this gatekeeper logic significantly reduces patient field wait with minimal impact on treatment day length for a four-room proton facility. A sample interface that adopts this logic for therapists to make informed decision on patient call-back time is demonstrated.

Experiences of Outpatient Clinics and Opinions of Telehealth by Caucasian and South Asian Patients' With Celiac Disease

Outpatient clinics are an important part of chronic disease management, including that of celiac disease. During the coronavirus disease 2019 (COVID-19) global pandemic, telephone and online video consultations with health care professionals have substantially increased. This study aimed to explore the experience and opinions of adults, with celiac disease, toward face-to-face clinic appointments and alternatives, such as telehealth. Semistructured qualitative interviews with 37 patients were undertaken (75% White Caucasians, 25% South Asians; 29 patients were not adhering to the gluten-free diet). Interviews were recorded, transcribed, and analyzed by NVivo. Frequently reported issues with face-to-face appointments included travel and car parking costs, needing to take time off work, and frequent changes to appointment time. In addition, South Asian patients highlighted issues with linguistics barriers. Telephone consultations were considered acceptable and practical by the majority of patients based on ease and convenience. Online video consultations were favored by just 9 patients, however it is acknowledged that since the COVID-19 pandemic, there has been a greater exposure to this type of technology. These patient experiences can inform health care service development and are not biased by external health concerns connected with in-person visits during the pandemic.

Exploring drivers of patient satisfaction using a random forest algorithm

Background

Patient satisfaction is a multi-dimensional concept that provides insights into various quality aspects in healthcare. Although earlier studies identified a range of patient and provider-related determinants, their relative importance to patient satisfaction remains unclear.

Methods

We used a tree-based machine-learning algorithm, random forests, to estimate relationships between patient and provider-related determinants and satisfaction level in two of the main patient journey stages, registration and consultation, through survey data from 411 patients at a hospital in Abu Dhabi, UAE. Radar charts were also generated to determine which type of questions—demographics, time, behaviour, and procedure—influence patient satisfaction.

Results

Our results showed that the ‘age’ attribute, a patient-related determinant, is the leading driver of patient satisfaction in both stages. ‘Total time taken for registration’ and ‘attentiveness and knowledge of the doctor/physician while listening to your queries’ are the leading provider-related determinants in each model developed for registration and consultation stages, respectively. The radar charts revealed that ‘demographics’ are the most influential type in the registration stage, whereas ‘behaviour’ is the most influential in the consultation stage.

Conclusions

Generating valuable results, the random forest model provides significant insights on the relative importance of different determinants to overall patient satisfaction. Healthcare practitioners, managers and researchers can benefit from applying the model for prediction and feature importance analysis in their particular healthcare settings and areas of their concern.

The prevalence and stressors of job burnout among medical staff in Liaoning, China: a cross-section study

BACKGROUND

Sustained attention to the prevalence and associated factors of burnout in China is important for the health care service quality and related reform. In this study, we investigated the prevalence of job burnout among medical staff in Liaoning province, China; performed a survey of subjective perception ranking for the main stressors among respondents; estimated the effect of stresses from work tasks and the relationship with patients on job burnout in order to provide improved strategy and suggestion for hospital administrators.

METHODS

The respondents were from 8 hospitals in 3 cities in Liaoning province, China. Data were collected and analyzed including the following sections: (1) demographic characteristics; (2) work situations; (3) ranking of six stressors; (4) job burnout scale; (5) effort-reward imbalance scale; (6) work violence scale; (7) fear of malpractice scale. A total of 1056 individuals became the study objects. A statistical analysis and hierarchical linear regression analysis were performed to explore the prevalence of burnout and the effects of stressors.

RESULTS

The prevalence of job burnout was 20.5, and 72.9% of all respondents reported a least one symptom of burnout. The respondents who were male, 30-39 years old, had a master's degree or high and working hours > 60 h per week, came from obstetrics and gynecology or pediatrics profession prone to job burnout. The relationship with patients and work tasks are the top two ranking stressors in the subjective perception survey. Regression analysis showed that the relationship with patients explained 19.2, 16.8 and 2.0% of variance in burnout subscales EE, DP and PA, respectively and work tasks explained 23.5, 16.0 and 5.24% of variance in burnout subscales EE, DP and PA, respectively.

CONCLUSION

The Chinese medical staff had high prevalence of job burnout. Some factors of demographic and work situations were associated with job burnout. The medical staff considered the relationship with patients and work tasks are the two major stressors. These two stressors are also the major indicators associated with job burnout. The hospital administrators should be aware of the risk of burnout. Efforts should be made to ameliorate the status of job burnout.

A Qualitative Exploration of Patients' Experiences with Lifestyle Changes After Sleeve Gastrectomy in China

PURPOSE

Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals' experiences related to lifestyle changes after SG in China.

MATERIALS AND METHODS

Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes.

RESULTS

Interviews (N = 15) revealed three major themes of participants' experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations.

CONCLUSION

The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.

Artificial intelligence-assisted reduction in patients' waiting time for outpatient process: a retrospective cohort study

Background

Many studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.

Methods

We developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides.

Results

Twelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05).

Conclusions

Using XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals.

[Pager-supported waiting time management in a university hospital ENT outpatient department : A pilot project for more distance and more comfort]

Hintergrund

Aufgrund der Pandemie mit dem neuartigen Coronavirus (SARS-CoV-2) sollte überall auf ausreichend Abstand zwischen Personen geachtet werden, insbesondere auch in Wartebereichen medizinischer Versorgungseinrichtungen. Bei oftmals eingeschränkten räumlichen Kapazitäten ist dies jedoch nicht immer problemlos realisierbar.

Ziel der Arbeit

Wir untersuchten die Möglichkeit, mittels eines Pagersystems den Patienten unserer HNO-Ambulanz eine Wartezeit außerhalb des eigentlichen Wartebereichs zu ermöglichen, um damit die Anzahl der Patienten im Wartebereich zu reduzieren, und die Einhaltung der Abstandsregeln zu gewährleisten.

Material und Methoden

In einer Zeitspanne von 12,5 Wochen (Beginn 04.06.2020, Ende 31.08.2020) erfolgte die Ausgabe von Pagern an die Patienten unserer HNO-Ambulanz. Teilnehmenden Patienten war es damit möglich, sich während der Wartezeit auf dem gesamten Klinikgelände frei zu bewegen. Der Pager wurde 10–15 min vor dem Termin aktiviert, und der Patient damit zurück in die HNO-Ambulanz gerufen. Mittels Fragebögen erfolgte eine Evaluation des Systems, um die Akzeptanz und Zufriedenheit der Patienten zu eruieren.

Ergebnisse

137 Fragebögen wurden analysiert, hierbei zeigte sich eine Zufriedenheit mit dem System – nicht nur, was die Einhaltung der Abstandsregeln betrifft, sondern auch bzgl. eines höheren Komforts während der Wartezeit.

Schlussfolgerung

Die Einführung eines Pagersystems für Patienten führt neben der Wahrung der Hygiene- und Abstandsregeln auch zu einer Erhöhung des Komforts während der (häufig nicht zu vermeidenden) Wartezeit für die Patienten in der universitären Ambulanz einer HNO-Klinik. Daher erscheint ein langfristiger Einsatz eines solchen Systems vielversprechend.

The perception gap of chemotherapy-induced adverse events between doctors and cancer patients: an observational study in China

INTRODUCTION

Patient-reported outcomes (PROs) have been widely accepted in western countries. However, limited attention has been given to PROs in China due to a lack of research on the agreement between doctors' and patients' reports of adverse events. This study aims to reveal the perception gap of chemotherapy-induced adverse events between doctors and cancer patients in China.

METHODS

An observational study was administered at Sun Yat-Sen University Cancer Center (SYSUCC). Totally, 200 adult cancer patients undergoing chemotherapy participated. Patient reports were collected by nurses via telephone. Doctor reports were collected by nurses based on their medical records. The agreement between doctors and patients was analyzed by Cohen's κ.

RESULTS

Agreement between doctors and patients varied among different symptoms: 0.26 for nausea/vomiting, 0.49 for constipation, 0.63 for diarrhea, 0.65 for general pain, and 0.76 for rash. Doctors' underreporting rates were 70% for nausea/vomiting, 50% for diarrhea, 38% for rash, 33% for constipation, and 29% for general pain.

CONCLUSIONS

The perception gap of chemotherapy-induced adverse events between doctors and patients exists in China, especially regarding subjective symptoms. Introduction of PROs in both clinical trials and routine clinical practice should be considered in China.

Stochastic programming for outpatient scheduling with flexible inpatient exam accommodation

This study is concerned with the determination of an optimal appointment schedule in an outpatient-inpatient hospital system where the inpatient exams can be cancelled based on certain rules while the outpatient exams cannot be cancelled. Stochastic programming models were formulated and solved to tackle the stochasticity in the procedure durations and patient arrival patterns. The first model, a two-stage stochastic programming model, is formulated to optimize the slot size. The second model further optimizes the inpatient block (IPB) placement and slot size simultaneously. A computational method is developed to solve the second optimization problem. A case study is conducted using the data from Magnetic Resonance Imaging (MRI) centers of Lahey Hospital and Medical Center (LHMC). The current schedule and the schedules obtained from the optimization models are evaluated and compared using simulation based on FlexSim Healthcare. Results indicate that the overall weighted cost can be reduced by 11.6% by optimizing the slot size and can be further reduced by an additional 12.6% by optimizing slot size and IPB placement simultaneously. Three commonly used sequencing rules (IPBEG, OPBEG, and a variant of ALTER rule) were also evaluated. The results showed that when optimization tools are not available, ALTER variant which evenly distributes the IPBs across the day has the best performance. Sensitivity analysis of weights for patient waiting time, machine idle time and exam cancellations further supports the superiority of ALTER variant sequencing rules compared to the other sequencing methods. A Pareto frontier was also developed and presented between patient waiting time and machine idle time to enable medical centers with different priorities to obtain solutions that accurately reflect their respective optimal tradeoffs. An extended optimization model was also developed to incorporate the emergency patient arrivals. The optimal schedules from the extended model show only minor differences compared to those from the original model, thus proving the robustness of the scheduling solutions obtained from our optimal models against the impacts of emergency patient arrivals.

Status and Factors Associated with Healthcare Choices among Older Adults and Children in an Urbanized County: A Cross-Sectional Study in Kunshan, China

As important unit for regional health planning, urbanized counties are facing challenges because of internal migrants and aging. This study took urbanized counties in China as cases and two key populations as objects to understand different populations' intentions of choosing corresponding health service resources and to provide support for resource allocation. A cross-sectional study was conducted in Kunshan, a highly urbanized county in China, in 2016, among older adults aged 60 or over and children aged 0-6. Multinomial logistics models were used to identify the factors associated with healthcare choices. In this study, we found that income, distance of the tertiary provider, and migrant status were not associated with choices of tertiary healthcare outside county for children, while parents' education level was. The responsiveness of the tertiary provider inside the county was lower than primary and secondary providers inside the county, while respondents were dissatisfied with the medical technology and medical facility for the tertiary inside the county compared to those of the tertiary provider outside the county. Significant differences existed in terms of the perception of different categories of institutions. To conclude, local governments should particularly seek to strengthen pediatric primary health services and improve the responsiveness of healthcare facilities to treat geriatric and pediatric diseases, which also bring significance to the developing countries in the process of urbanization.

Pregnant women's satisfaction with antenatal care services and its associated factors at public health facilities in the Harari region, Eastern Ethiopia

Background:

Antenatal care coverage is very low in low-and middle-income countries, including Ethiopia. Self-reported pregnant women’s satisfaction may be important in identifying the demographic, provider-, and facility-related factors that can be improved to increase antenatal care satisfaction. However, there is a paucity of data on pregnant women’s satisfaction in Ethiopia, particularly in the study setting. Therefore, this study aimed to assess antenatal care service satisfaction and associated factors among pregnant women at public health facilities in the Harari region of eastern Ethiopia.

Methods:

A health institution–based cross-sectional study was conducted among women who were attending antenatal care clinics in February 2017. All 531 pregnant women were selected using a systematic random sampling method. Data were collected using an interviewer-administered questionnaire, entered into EpiData version 3.1, and analyzed using SPSS version 22.0 software. A logistic regression model was applied to control for confounders. The level of significance was determined at a p-value of less than 0.05.

Results:

The magnitude of pregnant women’s satisfaction with antenatal care services was 70.3% (95% confidence interval (CI) = 66.4%–74.3%). Receiving antenatal care services from the hospital (adjusted odds ratio (AOR) = 2.44, 95% CI = 1.50–3.98), did not attend formal education (AOR = 2.53, 95% CI = 1.52–4.20) and attended primary education (AOR = 2.17, 95% CI = 1.17–4.04), having a repeated visit to antenatal care (AOR = 4.62, 95% CI = 2.98–7.17), initiating antenatal care services within the first trimester (AOR = 1.74, 95% CI = 1.12–2.71), having no history of stillbirth (AOR = 2.52, 95% CI = 1.37–4.65), and waiting for no more than 30 min in the health facility to get service (AOR = 2.31, 95% CI = 1.28–4.16) were factors associated with pregnant women’s satisfaction with antenatal care services.

Conclusion:

More than two-thirds of pregnant women were satisfied with the antenatal care service. The type of health facility, education status, number and initiation time of antenatal visit, history of stillbirth, and waiting time to get service were factors associated with pregnant women’s satisfaction with antenatal care services.

Encouraging Patient Engagement Behaviors from the Perspective of Functional Quality

Despite extensive research on how patient engagement behaviors (PEBs) are facilitated though explicit technical interventions in medical services, research on the encouragement of PEBs from the perspective of the service process is lacking. This study explores how functional quality dimensions (responsiveness, empathy, surroundings, and access) affect PEBs (compliance and loyalty) through a two-channel psychological mechanism (trust and satisfaction). This study tests the proposed model using survey data from two public hospitals in southeastern China and employs the partial least square (PLS) technique of structural equation modeling (SEM) to analyze the data. The results show that service providers’ responsiveness, empathy, and access affect patient compliance and loyalty through patient satisfaction; however, the effect of surroundings is not significant. The responsiveness and empathy of service staff affect PEBs through patient trust. Considering the high-contact professional nature of medical services, we call for more efforts toward improving service processes rather than simply relying on technical interventions. Specifically, hospitals and contact employees should devote time and effort to functional quality management in three dimensions, namely responsiveness, empathy, and access, to secure patient trust and satisfaction.