Spatial analysis and evaluation of medical resource allocation in China based on geographic big data

Temporal trends in gender, etiology, severity and outcomes of acute pancreatitis in a third-tier Chinese city from 2013 to 2021

BACKGROUND

To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

METHODS

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

RESULTS

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

CONCLUSIONS

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

The impact of nursing work environment, emotional intelligence, and empathy fatigue on nurses' presenteeism: a structural equation model

PURPOSE

This study aimed to investigate the impact of the work environment, emotional intelligence, and empathy fatigue on nurse presenteeism and to examine the mediating roles of emotional intelligence and empathy fatigue.

METHODS

This study employed a cross-sectional research design and conducted a questionnaire survey from April to July 2024 among 1,375 nurses (aged 18-24, 25-34, 35-44, and ≥ 45 years) from six tertiary hospitals in Henan Province. The questionnaire included demographic characteristics, the Nursing Practice Environment Scale, the Emotional Intelligence Scale, the Empathy Fatigue Scale, and the Stanford Presenteeism Scale. Statistical analyses were conducted using SPSS 27.0 and AMOS 26.0. A structural equation model was constructed, and the Bootstrap method was employed to assess the mediating effects.

RESULTS

The average presenteeism score among nurses was 19.49 ± 5.910. A partial mediation effect exists among the four variables: work environment, emotional intelligence, empathy fatigue, and nurse presenteeism. Specifically, the nursing work environment not only directly negatively influences nurse presenteeism but also indirectly affects it through the mediating roles of emotional intelligence and empathy fatigue. Furthermore, emotional intelligence and empathy fatigue serve as a chain mediator between the work environment and nurse presenteeism.

CONCLUSION

The results indicate that the nursing work environment not only directly affects nurse presenteeism but also indirectly influences their presenteeism through emotional intelligence and empathy fatigue. These findings provide theoretical support and guidance for reducing nurse presenteeism rates, emphasizing the importance of optimizing the nursing work environment, enhancing emotional intelligence, and alleviating empathy fatigue in nursing practice.

Investigating the relationship between social deprivation and health outcomes in China: using spatial regression analysis approach

BACKGROUND

Although significant progress has been made in the health status of Chinese citizens, disparities are still strikingly evident. This paper reveals the interconnection between social deprivation and the health of the Chinese population using the latest census data, and delves into the impact of social deprivation on health outcomes.

METHODS

To assess social deprivation, this study selected 14 indicators from six domains: income, employment, education, housing condition, housing area, and demographic structure. The social deprivation value was calculated using entropy method, variation coefficient method, CRITIC method, and principal component analysis method, and its spatial distribution was compared. Meanwhile, the best models are selected from ordinary least squares regression models, spatial lag models and spatial error models to analyze the effect of social deprivation on health outcomes according to the performances of these models.

RESULTS

The spatial distribution of social deprivation in China displays notable heterogeneity. The best models indicates that social deprivation is negatively correlated with mortality rate of Class A and B infectious diseases, average life expectancy and proportion of healthy elderly, but positively correlated with incidence rate of Class A and B infectious diseases, maternal mortality rate, and prevalence rate of low-weight children. The part of regression models for analyzing the relationship between social deprivation and metrics like incidence rate of infectious diseases, maternal mortality rate, average life expectancy, and proportion of healthy elderly are in the form of spatial lag. The part of regression models for analyzing the relationship between social deprivation with mortality rate of Class A and B infectious diseases and prevalence rate of low weight children are in the form of spatial error.

CONCLUSION

Social deprivation impacts the health of different populations, and this influence exhibits correlation and interaction across various regions. Therefore, it is necessary for governments to develop policies, particularly those aimed at enhancing the equality of public health services, to address the imbalance in regional development, allocate resources scientifically, and narrow the gap in economic, social, and healthcare development across regions.

Evolution of physician resources in China (2003-2021): quantity, quality, structure, and geographic distribution

INTRODUCTION

Physicians are an indispensable part of the healthcare system, crucial for maintaining public health. Since the issues in market-oriented healthcare reform emerged in 2003, China has implemented a series of healthcare system reforms to improve the equitable distribution of medical resources. The impact of these reform measures on the physician workforce has yet to be systematically assessed.

METHODS

Data were sourced from the China Health Statistics Yearbook from 2003 to 2021. We conducted a detailed descriptive statistical analysis of physicians' quantity, quality, and structure. The Gini coefficient was calculated to evaluate national physician distribution equity, and the Theil index was further used to analyze interprovincial and intraprovincial inequality trends in the physician workforce. Global Moran's I and hotspot analysis were employed to examine the spatial heterogeneity and clustering of physician labor.

RESULTS

The number of physicians increased from 1.87 million in 2003 to 4.29 million in 2021, with an average annual growth rate of 4.72%. The male-to-female ratio changed from 1:0.69 to 1:0.92. The main educational level of physicians elevated to a bachelor's degree (45.9%). However, the proportion of young doctors (< 35 years) declined from 41.1 to 26.0%. The Gini coefficient decreased from 0.140 in 2003 to 0.071 in 2021, and the Theil index dropped from 0.091 to 0.057. Decomposition of the Theil index revealed that overall differences in physician distribution primarily stemmed from intraprovincial inequality rather than interprovincial inequality. Global Moran's I decreased from 0.304 in 2003 to 0.109 in 2015 and then increased to 0.444 in 2021. Hotspot analysis showed uneven physician distribution, with high-value clusters in northern regions and low-value clusters in southern regions.

CONCLUSIONS

Over the past 19 years, despite improvements in the quantity and quality of physicians, the decline in young physicians and worsening regional disparities pose challenges.

The impact of the hierarchical medical system on medical resource allocation in China

The disparity in medical resource distribution across regions poses a significant challenge to healthcare reform in China. To address this, China has introduced the hierarchical medical system (HMS). This study evaluates the HMS's impact on the equitable distribution of medical resources. We employ the Theil index to quantify the equalization of resources among cities within provinces and use a multi-period difference-in-differences model to assess the HMS's influence. Our findings indicate that the HMS has significantly contributed to the equal distribution of medical material resources, although its effect on medical human resources is less pronounced. Additionally, we explore the influencing factors of the HMS from the perspective of supply and demand and find that it is more effective in areas with abundant resources and high demand for high-level medical services. More importantly, the HMS has played an important role in mitigating medical disparities in regions with unbalanced economic statuses. These insights are instrumental for policymakers, guiding the evolution of healthcare reforms and the refinement of the HMS to achieve the objective of universal health coverage.

The Epidemiological Landscape of Thyroid Cancer and Estimates of Overdiagnosis in China: A Population-Based Study

Background: In China, thyroid cancer (TC) is the most common cancer in females and the fifth most common cancer in males. TC overdiagnosis leads to overtreatment, lifelong medical care, and side effects. This study systematically quantifies the epidemiological profile of TC incidence in China, as well as estimating TC incidence attributable to overdiagnosis. Methods: Data were derived from the Cancer Incidence in Five Continents databases. Age-standardized incidence rates (ASIRs) per 100,000 person-years were calculated using the world standard population. Joinpoint regression and age-period-cohort models were conducted to examine temporal ASIR trends and period effects, respectively. We estimated TC incidence attributable to overdiagnosis among patients aged 15-84 years by comparing shapes of age-specific curves with those observed before diagnostic practices. Results: In 2013-2017, there were 37,862 and 117,979 new TC cases in males and females in China, respectively, with ASIRs of 6.9/100,000 and 21.1/100,000. Significant upward trends were observed from 1993 to 2017, with average annual percent changes being 14.7% for males and 16.2% for females. Incidence rate ratios of period effects markedly increased from 1.0 to 61.8 for males and from 1.0 to 42.9 for females from 1993 to 2017. Overdiagnosis accounted for 83.5% (31,455/37,685) and 88.7% (104,222/117,509) of cases in males and females in 2013-2017, respectively, yielding ASIRs of 5.9/100,000 and 19.1/100,000. ASIRs attributable to overdiagnosis in urban populations (6.9/100,000 for males and 21.7/100,000 for females) were significantly higher than in rural populations (1.3/100,000 and 6.4/100,000). Among the 25 included provinces, ASIRs attributable to overdiagnosis ranged from 0.3/100,000 in Sichuan to 18.5/100,000 in Shanghai in males and from 0.1/100,000 in Shanxi to 49.4/100,000 in Shanghai in females. The national ASIRs attributable to overdiagnosis increased from 2.6/100,000 in 2008-2012 to 5.9/100,000 in 2013-2017 for males and from 9.2/100,000 to 19.1/100,000 for females. Conclusions: The incidence rates of TC have considerably increased over the past 25 years in China. Rapidly increasing trends and considerable geographic variations in TC incidence attributable to overdiagnosis highlight the need to adjust TC screening strategies and clinical practices, optimize healthcare resource allocation, and monitor the impacts of TC overdiagnosis on population-level health.

DEA-based centralized resource allocation with a balance between efficiency and equity: evidence from healthcare services across 31 provinces in China

In the context of increasing investment in healthcare, the key issue of China's healthcare system reform is how to maximize output and ensure the equity of resource allocation. The generalized DEA-based resource allocation model (Model 1) pursues the maximization of DMU efficiency in resource allocation without considering equity, and it could yield a multi-solution problem by considering only the outputs instead of the inputs in the objective function. Thus, a DEA-based centralized resource allocation model with a balance between efficiency and equity (Model 2) is proposed, in which efficiency and equity are measured by output and input indicators in the objective function simultaneously, this could be more consistent with the essence of the DEA method. Model 2 effectively prevents the multi-solution problem by introducing both outputs and inputs into the objective function, and its Pareto-efficiency is proven. The main advantage of the proposed Model 2 is that efficiency and equity can be optimized in resource allocation; in particular, it can ensure equity for all DMUs in both absolute and relative terms. Furthermore, we illustrate and examine the application of Model 2 with centralized healthcare service resource allocation across 31 provinces in mainland China. We investigate the properties and effectiveness of Model 2 by comparison with Model 1 in terms of both efficiency and equity. Efficiency and equity are measured from three perspectives: efficiency values and slacks, input and output indicators, and allocation deviation. The results prove that Model 2 is superior to Model 1 in terms of both efficiency and equity.

Quantifying the impacts of volume-based procurement policy on spatial accessibility of antidepressants via generic substitution: A four-city cohort study using drug sales data

OBJECTIVE

To assess the spatial accessibility and inequality of antidepressants and its correlation with VBP (Volume-based procurement) policy using procurement data from four representative Chinese cities between 2018 and 2020.

METHODS

The least-cost-path algorithm was employed to calculate travel time from each population point to the nearest medical institution. Gini coefficient and Theil index were utilized to measure accessibility and inequality. OLS (Ordinary Least Squares) and mediation analysis were used to investigate potential statistical relationships.

RESULTS

Under the influence of the VBP policy, we observed varying degrees of growth in the procurement volumes of two antidepressants across different cities (Escitalopram: Beijing 30.3%, Shanghai 26.2%, Ningbo 37.4%, Harbin 25.7%; Paroxetine: Beijing 28.2%, Shanghai 1.2%, Ningbo 50.2%, Harbin 590.5%). The increase in the procurement volumes of antidepressants across cities was primarily driven by generic drugs (Escitalopram: Beijing 159.8%, Shanghai 75.0%, Ningbo 146.4%, Harbin 146.3%; Paroxetine: Beijing 67.3%, Shanghai 4.9%, Ningbo 58.0%, Harbin 15,758.3%). In the results on spatial inequality, we observed annual improvements across all cities, with more pronounced progress in economically underdeveloped regions (Escitalopram: Gini in Harbin decreased by 10.6%; Paroxetine: Gini in Harbin decreased by 32.6%). In Beijing, the substitution of generic escitalopram was found to be a partial mediating factor in the improvement of spatial inequality (ACME = -0.00, p-value = 0.01; ADE = -0.00, p-value = 0.02). In Harbin, the substitution of generic paroxetine was identified as a complete mediating factor for spatial inequality (ACME = -0.04, p-value = 0.01; ADE = 0.01, p-value = 0.14).

CONCLUSIONS

This study found that the spatial accessibility and inequality of antidepressant medications gradually improved under the influence of the VBP policy. These improvements can be partially attributed to the substitution of generic drugs.

Preoperative Analgesia Efficacy of Liposomal Bupivacaine Following Pericapsular Nerve Group (PENG) Block in Patients with Hip Fracture: A Randomized Controlled Observer-Blinded Study

INTRODUCTION

Single-injection pericapsular nerve group (PENG) block with ropivacaine provides clear analgesic effects in preoperative pain management for hip fractures. However, it suffers from insufficient duration, failing to meet the needs of most patients. This single-center, randomized controlled, observer-blinded trial utilizes a novel combination of liposomal bupivacaine (LB) single-injection PENG block to examine its efficacy, duration, and safety in preoperative analgesia for hip fractures, aiming to develop a new preoperative analgesic protocol.

METHODS

Sixty-six patients with hip fractures received ultrasound-guided single-injection PENG block with LB or ropivacaine after admission. The primary outcome was the static and dynamic pain scores measured at 48 h post-block. Pain scores at 12, 24, 36, 60, and 72 h post-block, rescue analgesia rate, time to first opioid, additional morphine consumption, and adverse events were assessed as the secondary outcomes.

RESULTS

LB versus ropivacaine group at 48 h post-block, with a median interquartile range (IQR) of 2 (1.0-2.0) versus 3 (2.0-3.0) at static pain score and 2 (1.75-3.0) versus 4 (4.0-5.0) at dynamic pain score. LB group had lower dynamic and static pain scores at other observation points except for the static pain score at 72 h, lower pain intensity [sum of pain intensity difference (SPID)0-24, SPID0-48 and SPID0-72], longer time to first opioid, lower additional morphine consumption, and lower incidence of nausea and vomiting. No significant inter-group differences were detected in other secondary outcomes.

CONCLUSIONS

For preoperative analgesia of hip fractures, LB single-injection PENG block had a similar analgesic intensity and safety as ropivacaine but provided a longer duration of analgesia, reaching 48 h and even extending beyond 60 h, which reduced opioid consumption and extended time to the first opioid.

TRIAL REGISTRATION

The protocol was registered in  www.chictr.org.cn  under the identifier ChiCTR2300072939.

Can the digital economy foster advancements in the healthcare sector? - a case study using interprovincial data from China

BACKGROUND

As China's "Internet + Health" initiative advances, the digital economy significantly influences the quality of medical and health services. However, there is a research gap concerning the digital economy's specific impacts, mechanisms, and marginal effects on these services. This gap impedes a comprehensive understanding of the digital economy's potential in healthcare.

AIMS

This study aims to clarify the digital economy's impact mechanisms on medical and health services levels, offering a scientific foundation for more targeted and effective policy formulation, thereby fostering sustainable digital development in healthcare.

METHODS

Utilizing panel data from China's 31 provinces (2011-2020), this paper employs the Spatial Durbin Model to analyze the spatial and marginal effects of the digital economy on healthcare service levels. To ensure analysis accuracy and robustness, the study refines the spatial weight matrix and addresses model endogeneity using the Generalized Spatial Two-Stage Least Squares method. Additionally, it examines regional disparities in the digital economy's impact through SDM and explores intermediary mechanisms and threshold effects using a mediation effect model and a panel threshold model.

RESULTS

Findings indicate that the digital economy positively affects medical and health services in both local and neighboring regions, with variations across areas. The eastern region particularly benefits from the digital economy's enhancement of service levels, while the central and western regions see less impact. The digital economy enhances services by improving medical resource levels and promoting their coordinated development. However, this positive effect is moderated by the digital economy's and the region's economic development levels, with more pronounced impacts in regions with higher digital and economic development.

CONCLUSIONS

The digital economy plays a crucial role in improving medical and health services, and its full potential is beneficial for the industry's advancement and sustainability. Nonetheless, addressing the uneven digital economy development across regions is essential to ensure equitable benefits for all areas.

Geographic variations, temporal trends, and equity in healthcare resource allocation in China, 2010-21

Background

Inequity in healthcare resources has been identified as a global public health priority, yet the geographic variations and temporal trends in distribution and inequity in China remain unclear. We aimed to investigate these variations and temporal trends in healthcare resources and evaluate inequity in healthcare resource allocation in China.

Methods

In this nationwide descriptive study, we used provincial-level data on healthcare infrastructure, human, and service resources from 31 provinces of mainland China, publicly released by the National Health Commission of China between 2010-21. We assessed the spatial autocorrelation of healthcare infrastructure, human, and service resources using Moran's I index, and identified spatial clusters of resource allocation. We evaluated the equity in healthcare resource allocation using the Lorenz curve, Gini coefficient, and Theil index by population and geographic dimensions.

Results

Between 2010-21, the density of healthcare infrastructure and human resources in China increased, with the average stay decreasing from 10.5 to 9.2 days. There were substantial regional disparities, with higher resource density exhibited in eastern regions compared to western regions. Spatial autocorrelation was more pronounced for the density of practising (assistant) physicians (Moran's I = 0.465; P < 0.001), practising physicians (Moran's I = 0.351; P < 0.001), and bed occupancy rate (Moran's I = 0.256; P < 0.001), with significant geographic clusters of resource allocation. Lorenz curves showed that healthcare resource allocation was closer to the absolute equity by population but not geographic dimension, with Gini coefficients indicating severe inequity (>0.6) by geographic dimension compared to perfect equity (<0.2) by population dimension. Intraregional Theil index by population was higher than the inter-regional index, with contribution rates exceeding 60%.

Conclusions

Per capita access to healthcare resources in China has improved, but significant geographic variations and clustering exist, particularly with higher resource density in eastern regions. While resource allocation by population showed better equity than by geographic area, substantial intra-regional disparities highlight the need for targeted strategies to enhance equitable distribution, particularly in the western regions.

Exploring the influencing factors of patients sending red packets and the necessity of doctor-patient red packet agreements

Objective

To investigate the influencing factors of inpatients giving red packets to doctors and explore the necessity of doctor-patient red packet agreements.

Methods

A questionnaire survey was conducted among inpatients and their families who were hospitalized in several hospitals in Chengdu from January to June 2023. The survey asked about the patients' (or their families') attitudes and opinions on whether it was necessary to give red packets to doctors during hospitalization.

Results

The vast majority of patients (80.7%) thought that it was not necessary to give red packets to doctors, and 87.0% of patients had never given red packets. 59.7% of patients chose senior doctors as the recipients of red packets, and 90.0% of patients thought that it was necessary to give red packets to doctors in 3A-grade hospitals. Patients' attitudes toward giving red packets were positively influenced by their education level and previous experience of giving red packets.

Conclusion

Despite education level and previous experience of giving red packets were all positive influencing factors for patients giving red packets, the proportion of patients who had given or intended to give red packets was relatively low. The majority of patients believed that giving red packets was unnecessary, and they held the view that doctors would not treat them less actively if they did not receive red packets. The question of whether signing a red packet agreement is necessary is worth contemplating at this time.

Spatial-temporal distribution and evolution of medical and health talents in China

BACKGROUND

In the context of public health emergencies, the presence of medical and health talents (MHT) is critically important for support in any country or region. This study aims to analyze the spatial and temporal distributions and evolution of MHT in China and propose strategies and recommendations for promoting a balanced distribution.

METHODS

This research used data from 31 provinces in China to construct a multidimensional index system for measuring the agglomeration level of MHT. The indices include talent agglomeration density (TAD), talent agglomeration scale (TAS), talent agglomeration intensity (TAI), and talent agglomeration equilibrium (TAE). Using provincial data from the years 1982, 1990, 2000, 2010, and 2020, a spatiotemporal analysis of the MHT agglomeration levels was conducted. Furthermore, the regional dynamic distribution of MHT was analyzed using kernel density estimation diagrams. The spatial autocorrelation of MHT was assessed through global and local Moran's I, and the spatial gap and decomposition of MHT were analyzed using the Dagum Gini coefficient.

RESULTS

From the temporal level, the TAD and TAI of MHT showed an increasing trend over the studied period, whereas TAS decreased and TAE first increased and then decreased from 1982 to 2020. At the spatial level, the TAD, TAS, TAI, and TAE of MHT exhibited varied patterns among the eastern, central, and western regions of China, showing significant geographical disparities, generally demarcated by the Hu Huanyong Line. The regional dynamic distribution level of MHT in the country and the three regions were expanding. Spatial autocorrelation analysis using global and local Moran's I for TAD, TAS, TAI, and TAE demonstrated significant regional differences. The Dagum Gini coefficient of TAD, TAS, TAI, and TAE revealed divergent trends in regional disparities, with overall declines in disparities for TAD and TAI, a slight increase for TAS, and fluctuating patterns for TAE.

CONCLUSIONS

From a temporal perspective, the overall number of MHT in China has been increasing annually at the national and provincial levels. From the spatial perspective, TAD, TAS, TAI, and TAE exhibit significant differences among the three regions. Kernel analysis reveals that the distribution differences are gradually expanding in national level and varying in regional level. Moreover, the global and local Moran's I indices reveal varying spatial autocorrelation for TAD, TAS, TAI, and TAE. The Dagum Gini coefficients of TAD, TAS, TAI, and TAE show different patterns of decomposition.

Measuring social vulnerability in communities and its association with leprosy burden through spatial intelligence in central West Brazil to guide strategic actions

BACKGROUND

It is known that leprosy is a socially determined disease, but most studies using spatial analysis have not considered the vulnerabilities present in these territories.

OBJECTIVES

To measure the association between social vulnerability and the burden of leprosy in the urban space of Cuiabá.

METHODS

Ecological study, carried out in Cuiabá, Brazil. Diagnosed cases of leprosy were surveyed through the Notifiable Diseases Information System, from 2008 to 2018. The spatial scan statistics technique of leprosy cases per each Human Development Unit was applied. Social vulnerability was measured based on the Municipal Human Development Index (MHDI), education level and average per capita income. For the spatial correlation between vulnerability and leprosy, Global and local bivariate Moran's index was used.

RESULTS

8389 cases of leprosy were georeferenced, the majority being male (58%), 30% of cases were not evaluated for degree of physical disability. One of the spatial scan clusters had a relative risk (RR) of 6.93 (95% CI 6.49-7.4), and another had 1360 cases with RR 1.71 (95% CI 1.62-1.82). The bivariate global autocorrelation of Moran's index for MHDI was 0.579, observing 1 High-High in the East region and 1 in South, for education the index was 0.429, 2 High-High in the East and 1 in the South, and 0.145 for average per capita income, 1 High-High in the East.

CONCLUSION

There was a spatial association between leprosy cases and territories with low MHDI, having a percentage of the population without schooling and/or with low income. The study advances knowledge by presenting characteristics of territories most affected by leprosy, verifying the spatial correlation of the disease with the recurrent socioeconomic characteristics in these territories.

Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory Among Chinese Patients with Chronic Non-Specific Low Back Pain

Purpose

This research aims to develop and validate the Chinese version of the Central Sensitization Inventory (CSI-CV) for patients suffering from chronic non-specific low back pain (CNSLBP). The study evaluates both the validity and reliability of the CSI-CV.

Patients and Methods

The cross-cultural adaptation of the scale strictly adhered to the principles of Bombardier and Beaton. Initially, two professors of Chinese-English translation independently translated the original CSI scale into the target language, and then collaborated with an expert in cross-cultural adaptation to merge into a single version. This version was back-translated into English by two professors whose native language is English. Following this, the scale underwent preliminary review by bilingual experts and the research team, and was preliminarily tested, ultimately culminating in the formation of the CSI-CV version. A total of 310 patients with CNSLBP completed the CSI-CV, while 50 of them repeated the survey one week later to test the stability of the scale. The CSI-CV's reliability, validity, and internal consistency were assessed through exploratory factor analysis (EFA), correlation coefficients, and Cronbach's α.

Results

EFA revealed five distinct factors from the 25 CSI-CV items, covering physical symptoms, emotional distress, fatigue and sleep disturbances, headaches and jaw symptoms, and urinary issues, with a total explained variance of 60.24%. The Cronbach's α was 0.910, and the intraclass correlation coefficient (ICC) was 0.924, indicating strong reliability. Moderate correlations were observed between CSI-CV scores and Five-Level EuroQol Five-Dimensional Questionnaire (r = -0.515), the Brief Pain Inventory (r = 0.586) and Oswestry Disability Index (r = 0.416), demonstrating significant associations with these measures.

Conclusion

The CSI-CV exhibits excellent internal consistency, factor structure, and reliability. Its successful cultural adaptation offers valuable insights for improving treatment approaches for patients with CNSLBP.

The matching relationship and driving mechanism of elderly medical care resources and elderly population in China: A study based on provincial perspective

With the exacerbation of population aging in China, policies have been formulated to provide elderly medical care resources. However, research on the matching situation of these resources with the elderly population (EP) is relatively scarce. This study collected data on elderly medical care resources and the EP from various provinces in mainland China from 2011 to 2017. Using Spearman analysis, the correlation between elderly medical care resources and the EP was explored. Based on geographical concentration, the resource and population matching conditions of each province were calculated and categorized, while the deviation across the nation was measured. Finally, panel regression was used to identify driving factors affecting provincial matching degrees. From 2011 to 2017, the EP aged 60 or above in China grew from 173 million to 235 million, an increase of 35.84%. In contrast, the number of elderly medical care beds grew from 118,000 in 2011 to 135,000 in 2017, an increase of only 14.41%. Although a positive correlation has emerged between China's elderly medical care resources and the EP in recent years, the deviation between the two has been expanding annually. Among all provinces, more than one-third still lag behind in terms of elderly medical care resources. Moreover, the matching degree is closely related to economic levels, with significant differences observed between the eastern and western regions-the developed eastern regions have higher matching rates, while the less developed regions experience lower rates. The driving factors influencing provincial matching degrees have been identified as per capita GDP (β = 0.67, P = .010) and fiscal health expenditure (β = 0.22, P < .001). The matching degree between elderly medical care resources and the EP in China urgently needs to be improved. Economic conditions have a significant impact on the matching degree. To better serve the EP, it is needed to increase investments in elderly medical care resources in the western and northeastern regions, and promote an increase in the matching degree by enhancing per capita gross domestic product and fiscal health expenditure.

National, regional and provincial prevalence of childhood hypertension in China in 2020: a systematic review and modelling study

BACKGROUND

Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.

METHODS

For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).

FINDINGS

We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6-18 years was 3·11% (95% CI 2·35-4·04), equivalent to 6·80 million (5·13-8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54-2·75) for children aged 6 years to 2·01% (1·36-3·37) for those aged 18 years, peaking at 3·84% (2·97-4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53-4·35]) than in girls (2·85% [2·13-3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.

INTERPRETATION

This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.

FUNDING

This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

The digital transformation of nursing practice: an analysis of advanced IoT technologies and smart nursing systems

Facing unprecedented challenges due to global population aging and the prevalence of chronic diseases, the healthcare sector is increasingly relying on innovative solutions. Internet of Things (IoT) technology, by integrating sensing, network communication, data processing, and security technologies, offers promising approaches to address issues such as nursing personnel shortages and rising healthcare costs. This paper reviews the current state of IoT applications in healthcare, including key technologies, frameworks for smart nursing platforms, and case studies. Findings indicate that IoT significantly enhances the efficiency and quality of care, particularly in real-time health monitoring, disease management, and remote patient supervision. However, challenges related to data quality, user acceptance, and economic viability also arise. Future trends in IoT development will likely focus on increased intelligence, precision, and personalization, while international cooperation and policy support are critical for the global adoption of IoT in healthcare. This review provides valuable insights for policymakers, researchers, and practitioners in healthcare and suggests directions for future research and technological advancements.

Can China's national comprehensive medical reform increase medical resources and reduce healthcare burden: evidence from Chinese provinces

Objectives

China's national comprehensive medical reform (NCMR) is an important attempt in the reform of healthcare system, and quantitative evaluation of its effect is of great significance for continuously deepening medical reform, grasping the reform direction, and building a healthy China. Therefore, focusing on medical resources and medical burden, this study aims to systematically explore the policy effectiveness and the provincial heterogeneity of NCMR, as well as the potential influencing factors.

Methods

Utilizing the collected multi-period panel data of 31 provinces in mainland China in 2006-2021, we regarded the release of the two batches of pilot provinces in NCMR as a quasi-natural experiment and comprehensively adopted a Staggered difference-in-differences (DID) model and Synthetic Control Method (SCM), combined with word frequency statistics and grouping regression analysis.

Results

NCMR can effectively increase the number of licensed physicians by 12.6% and reduce the per capita medical expense for in-patients by 7.2% in the pilot provinces. Furthermore, the NCMR policy effect in different pilot provinces shows various characteristics, and only Jiangsu, Zhejiang, and Chongqing achieve both the growth of medical resources and the reduction of medical expenditure. Meanwhile, word frequency statistics are conducted based on related policy descriptions and news reports on the official websites, so as to summarize the specific policy means in the three provinces, and provide a reference for other provinces to practice the healthcare reforms. Besides, extensibility analysis shows that the effect of NCMR is affected by the population aging and health status. Groups with low degree of population aging (low-AG)/high population health status (high-HE) performed a more obvious reform effect.

Conclusion

This study provides beneficial policy implications for increasing medical resources, reducing medical burden, and promoting medical reform process.

Accessibility, Cost, and Quality of an Online Regular Follow-Up Visit Service at an Internet Hospital in China: Mixed Methods Study

BACKGROUND

Telemedicine provides remote health care services to overcome constraints of time and space in accessing medical care. Similarly, internet hospitals in China support and provide remote health care services. Due to the COVID-19 pandemic, there has been a proliferation of internet hospitals. Many new services, including online consultations and regular online follow-up visit services, can now be accessed via internet hospitals in China. However, the accessibility, cost, and quality advantages of regular online follow-up visit services remain unclear.

OBJECTIVE

This study aimed to evaluate the accessibility, costs, and quality of an online regular follow-up visit service provided by an internet hospital in China. By analyzing the accessibility, costs, and quality of this service from the supply and demand sides, we can summarize the practical and theoretical experiences.

METHODS

A mixed methods study was conducted using clinical records from 18,473 patients receiving 39,239 online regular follow-up visit services at an internet hospital in 2021, as well as interviews with 7 physicians, 2 head nurses, and 3 administrative staff members. The quantitative analysis examined patient demographics, diagnoses, prescriptions, geographic distribution, physician characteristics, accessibility (travel time and costs), and service hours. The qualitative analysis elucidated physician perspectives on ensuring the quality of online health care.

RESULTS

Patients were predominantly middle-aged men with chronic diseases like viral hepatitis who were located near the hospital. The vast majority were from Guangdong province where the hospital is based, especially concentrated in Guangzhou city. The online regular follow-up visit service reduced travel time by 1 hour to 9 hours and costs by ¥6 to ¥991 (US $0.86-$141.32) depending on proximity, with greater savings for patients farther from the hospital. Consultation times were roughly equivalent between online and in-person visits. Physicians provided most online services during lunch breaks (12 PM to 2 PM) or after work hours (7 PM to 11 PM), indicating increased workload. The top departments providing online regular follow-up visit services were Infectious Diseases, Rheumatology, and Dermatology. The most commonly prescribed medications aligned with the prevalent chronic diagnoses. To ensure quality, physicians conducted initial in-person consultations to fully evaluate patients before allowing online regular follow-up visits, during which they communicated with patients to assess conditions and determine if in-person care was warranted. They also periodically reminded patients to come in person for more comprehensive evaluations. However, they acknowledged online visits cannot fully replace face-to-face care.

CONCLUSIONS

Telemedicine services such as online regular follow-up visit services provided by internet hospitals must strictly adhere to fundamental medical principles of diagnosis, prescription, and treatment. For patients with chronic diseases, online regular follow-up visit services improve accessibility and reduce cost but cannot fully replace in-person evaluations. Physicians leverage various strategies to ensure the quality of online care.

Incentivizing primary care utilization in China: the impact of health insurance coverage on health-seeking behaviour

China's healthcare system faces significant challenges, notably the underutilization of primary healthcare resources and the inefficient distribution of healthcare services. In response, this article explores the effectiveness of the New Rural Cooperative Medical System (NRCMS) in improving healthcare accessibility and primary care utilization. Employing a multi-period difference-in-differences model and using data from the China Family Panel Studies spanning 2012-20, it aims to empirically examine how health insurance policy incentivizing primary care influences rural residents' health-seeking behaviour and enhances the efficiency of resource utilization. Results indicate that NRCMS significantly improves the probability of rural residents seeking healthcare services at primary healthcare centres (PHCs), especially for outpatient services. This effect can be attributed to the substantially higher outpatient reimbursement rates at PHCs compared to higher-level medical institutions. Conversely, the Urban Resident Basic Medical Insurance fails to increase urban residents' engagement with primary care, reinforcing the role of price sensitivity in healthcare choices among insured lower-income rural population. Furthermore, the study reveals a stronger preference for PHCs among younger, less-educated insured residents and highlights a synergistic effect between the availability of primary healthcare resources and insurance coverage on primary care utilization. These findings offer crucial implications for refining health insurance policies to improve healthcare service accessibility and efficiency.

Regional differences, dynamic evolution, and influencing factors of high-quality medical resources in China's ethnic minority areas

Background

In China, as people's standard of living improves and the medical service system becomes more sophisticated, the demand for higher-quality and improved healthcare services is steadily rising. Inequality in health resource allocation (HRA) is more pronounced in ethnic minority areas (EMAs) than in developed regions. However, little research exists on high-quality medical resources (HQMRs) in China's EMAs. Hence, we examined the spatiotemporal dynamic evolution of HQMRs in China's EMAs from 2007 to 2021 and identified the main factors affecting their respective HQMR levels.

Methods

We selected tertiary hospitals to represent the quality of healthcare resources. We employed descriptive statistical techniques to analyze changes in the distribution of HQMRs from 2007 to 2021. We used the Dagum Gini coefficient and kernel density approach to analyze the dynamic evolution of HQMRs in China's EMAs. We utilized the least squares dummy variable coefficient (LSDVC) to identify key factors affecting HQMR.

Results

The number of HQMRs in each EMA has risen annually. The average number of tertiary hospitals increased from 175 in 2007 to 488 in 2021. The results of the Dagum Gini coefficient revealed that the differences in the HQMR level in China's EMAs have slowly declined, and intra-regional disparities have now become the primary determining factor influencing overall variations. The kernel density plot indicated that the HQMR level improved significantly during the study period, but bifurcation became increasingly severe. Using the LSDVC for analysis, we found that gross domestic product (GDP) per capita, the size of the resident population, and the number of students enrolled in general higher education exhibited a significant negative correlation with HQMR levels, while GDP and urbanization rate had a significant promoting effect.

Conclusion

The HQMR level in EMAs has risen rapidly but remains inadequate. The differences in HQMR between regions have continued to narrow, but serious bifurcation has occurred. Policymakers should consider economic growth, education, and population size rather than simply increasing the number of HQMRs everywhere.

Spatially clustered patterns of suicide mortality rates in South Korea: a geographically weighted regression analysis

BACKGROUND

Suicide mortality remains a global health concern, and community characteristics affect regional variations in suicide. This study investigated spatially clustered patterns of suicide mortality rates in South Korea and evaluated the impact of community factors on suicide.

METHODS

Suicide mortality rates were estimated by sex, age group, and district, using the 2021 Cause of Death Statistics in South Korea from the MicroData Integrated Service. Community-determinant data for 2021 or the nearest year were collected from the Korean Statistical Information Service. The spatial autocorrelation of suicide by sex and age was examined based on Global Moran's I index. Geographically weighted regression (GWR) was used to discern the influence of community determinants on suicide.

RESULTS

Suicide mortality rates were significantly higher among men (40.64 per 100,000) and adults over the age of 65 years (43.18 per 100,000). The male suicide mortality rates exhibited strong spatial dependence, as indicated by a high global Moran's I with p < 0.001, highlighting the importance of conducting spatial analysis. In the GWR model calibration, a subset of the community's age structure, single-person household composition, access to mental healthcare centers, and unmet medical needs were selected to explain male suicide mortality. These determinants disproportionately increased the risk of male suicide, varying by region. The GWR coefficients of each variable vary widely across 249 districts: aging index (Q1:0.06-Q3:0.46), single-person households (Q1:0.22-Q3:0.35), psychiatric clinics (Q1:-0.20-Q3:-0.01), and unmet medical needs (Q1:0.09-Q3:0.14).

CONCLUSIONS

Community cultural and structural factors exacerbate regional disparities in suicide among men. The influencing factors exhibit differential effects and significance depending on the community, highlighting the need for efficient resource allocation for suicide. A regionally tailored approach is crucial for the effective control of the community's mental health management system.

Psychological Well-being of Patients in Reproductive Medicine Center: Clinicians' Perspectives

OBJECTIVES

This qualitative study aimed to comprehend the psychological well-beings and available interventions of current Chinese infertile patients, as well as investigate more integrated and effective patient support interventions, if necessary.

BACKGROUND

It is well known that infertility is a difficult struggle. Assisted reproductive technologies (ART) provide patients with the hope of having a child, but they also cause them pain and stress. There is a dearth of research on the mental health of infertile patients, particularly in developing nations such as China.

METHOD

Individual interviews were conducted with eight experienced clinicians at the Reproductive Medicine Center from five different hospitals. On the basis of the grounded theory, interviews were transcribed and recursively analysed with the NVivo 12 Plus software by a research team.

RESULTS

73 categories were created, which were then grouped into 12 subthemes that were combined to form the following themes: Theme I: Psychological Distress; Theme II: Sources of Distress; Theme III: Protective Factors; and Theme IV: Interventions.

CONCLUSIONS

The themes of subjective experience identified in the study reveal infertile patients' emotional disturbance and resources of distress, consistent with previous related studies. Despite limitations such as the relatively small number of participants and the exclusively self-report nature of qualitative study, the findings of the study imply the importance of emotional and physical support networks for infertile patients at Reproductive Medicine Centers, consistency of psychological awareness and adequate professional supports.

Novel ultrasound capsule endoscopy for gastrointestinal scanning: An in vivo animal study

Background and objectives

EUS is an important modality for diagnosis and assessment of gastrointestinal (GI) subepithelial lesions. However, EUS is invasive and operator-dependent and requires sedation in most cases. The newly developed ultrasound capsule endoscopy (USCE) system, with both white-light and ultrasound imaging modalities, is a minimally invasive method for superficial and submucosal imaging of the esophagus. This animal study aimed to evaluate the feasibility and efficacy of the USCE system for upper GI tract and small bowel scanning.

Methods

Three Bama miniature pigs were selected to scan their esophagus, stomach, small bowel, and simulated submucosal lesions. USCE was performed first, followed by EUS. The feasibility of USCE was measured by obtaining ultrasound images of normal GI walls and submucosal lesions under the guidance of optical viewing. The efficacy of USCE was evaluated by comparing tissue structures and lesion features shown on ultrasound images obtained with both instruments.

Results

Under the optical mode of USCE, the GI tract was well visualized, and all simulated lesions were located. Clear ultrasound images of normal GI tract and submucosal lesions were acquired. Ultrasound images of the esophagus, stomach, and small bowel were characterized by differentiated multilayer structures on USCE, which was consistent with the structures displayed on EUS. And the visualization of submucosal lesions, using both USCE and EUS, was characterized by a hypoechoic and well-demarcated mass in the layer of submucosa.

Conclusions

This animal study indicated the feasibility and potential clinical efficacy of this USCE for simultaneous optical mucosal visualization and transmural ultrasound imaging of upper GI tract and small bowel, providing possibility of using this technology for a wider range of GI tract.

Identifying determinants of spatial agglomeration of healthcare resources by using spatial econometric methods: a longitudinal study in China

Background

Healthcare resources are necessary for individuals to maintain their health. The Chinese government has implemented policies to optimize the allocation of healthcare resources and achieve the goal of equality in healthcare for the Chinese people since the implementation of the new medical reform in 2009. Given that no study has investigated regional differences from the perspective of healthcare resource agglomeration, this study aimed to investigate China's healthcare agglomeration from 2009 to 2017 in China and identify its determinants to provide theoretical evidence for the government to develop and implement scientific and rational healthcare policies.

Methods

The study was conducted using 2009-2017 data to analyze health-resource agglomeration on institutions, beds, and workforce in China. An agglomeration index was applied to evaluate the degree of regional differences in healthcare resource allocation, and spatial econometric models were constructed to identify determinants of the spatial agglomeration of healthcare resources.

Results

From 2009 to 2017, all the agglomeration indexes of healthcare exhibited a downward trend except for the number of institutions in China. Population density (PD), government health expenditures (GHE), urban resident's disposable income (URDI), geographical location (GL), and urbanization level (UL) all had positive significant effects on the agglomeration of beds, whereas both per capita health expenditures (PCHE), number of college students (NCS), and maternal mortality rate (MMR) had significant negative effects on the agglomeration of institutions, beds, and the workforce. In addition, population density (PD) and per capita gross domestic product (PCGDP) in one province had negative spatial spillover effects on the agglomeration of beds and the workforce in neighboring provinces. However, MMR had a positive spatial spillover effect on the agglomeration of beds and the workforce in those regions.

Conclusion

The agglomeration of healthcare resources was observed to remain at an ideal level in China from 2009 to 2017. According to the significant determinants, some corresponding targeted measures for the Chinese government and other developing countries should be fully developed to balance regional disparities in the agglomeration of healthcare resources across administrative regions.

Retrospective analyses of routine preoperative blood testing in a tertiary eye hospital: could Choosing Wisely work in China?

AIMS

To explore the possibility of implementing Choosing Wisely on ocular patients in China by investigating the prevalence of abnormalities in routine preoperative blood tests (RPBTs) and its turnaround time (TAT).

METHODS

Data from 102 542 ocular patients between January 2016 and December 2018, at Zhongshan Ophthalmic Center, were pooled from the laboratory information system. The test results were divided into normal and abnormal, including critical values. Ocular diseases were stratified into 11 subtypes based on the primary diagnosis. The TAT of 243 350 blood tests from January 2017 to December 2018 was categorised into transportation time and intralaboratory time.

RESULTS

RPBT was grouped into complete blood count (CBC), blood biochemistry (BBC), blood coagulation (BCG) and blood-borne pathogens (BBP), completed for 97.22%, 87.66%, 94.41% and 95.35% of the recruited patients (male, 52 549 (51.25%); median(IQR) age, 54 (29-67) years), respectively. Stratified by the test items, 9.19% (95% CI 9.07% to 9.31%) were abnormal results, and 0.020% (95% CI 0.019% to 0.022%) were critical; most abnormalities were on the CBC, while glucose was the most common critical item. Classified by the patients' primary diagnosis, 76.97% (95% CI 76.71% to 77.23%) had at least one abnormal result, and 0.28% (95% CI 0.25% to 0.32%) were critical; abnormal findings were reported in 45.29% (95% CI 44.98% to 45.60%), 54.97% (95% CI 54.65% to 55.30%), 30.29% (95% CI 30.00% to 30.58%) and 11.32% (95% CI 11.12% to 11.52%) for the CBC, BBC, BCG and BBP tests, respectively. The median transportation time and intralaboratory TAT of the samples were 12 min and 78 min respectively.

CONCLUSION

Blood abnormalities are common in ocular patients. With acceptable timelines, RPBT is still indispensable in China for patient safety.

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

BACKGROUND

Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala.

METHODS

This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model.

RESULTS

Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology.

CONCLUSION

Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.

COVID-19 patient satisfaction and associated factors in telemedicine and hybrid system

Background

The quality assessment of the home-based isolation and care program (HBIC) relies heavily on patient satisfaction and length of stay. COVID-19 patients who were isolated and received HBIC were monitored through telephone consultations (TC), in-person TC visits, and a self-reporting application. By evaluating patient satisfaction and length of stay in HBIC, healthcare providers could gauge the effectiveness and efficiency of the HBIC program.

Methods

A cross-sectional study design enrolled 444 HBIC patients who answered a structured questionnaire. A binary logistic regression model assessed the association between independent variables and patient satisfaction. The length of stay in HBIC was analyzed using Cox regression analysis. The data collection started on April (1-30), 2022, in Addis Ababa, Ethiopia.

Results

The median age was 34, and 247 (55.6%) were females. A greater proportion (313, 70.5%) of the participants had high satisfaction. Higher frequency of calls (>3 calls) (AOR = 2.827, 95% CI = 1.798, 4.443, p = 0.000) and those who were symptomatic (AOR = 2.001, 95% CI = 1.289, 3.106, p = 0.002) were found to be significant factors for high user satisfaction. Higher frequency of calls (>3 calls) (AHR = 0.537, 95% CI = 0.415, 0.696, p = 0.000) and more in-person visits (>1 visit) (AHR = 0.495, 95% CI = 0.322, 0.762, p = 0.001) had greater chances to reduce the length of stay in the COVID-19 HBIC.

Conclusion

70.5% of the participants had high satisfaction with the system, and frequent phone call follow-ups on patients' clinical status can significantly improve their satisfaction and length of recovery. An in-person visit is also an invaluable factor in a patient's recovery.

Randomized controlled trial of an app for cancer pain management

PURPOSE

The primary objective of this investigation was to devise a mobile application for self-management of cancer-related discomfort, with the overarching goal of enhancing patients' overall well-being. Would the utilization of the self-management application result in an amelioration of life quality compared to conventional follow-up procedures?

METHODS

Modules were meticulously devised with the collaborative expertise of oncology pain specialists employing the Delphi technique. Reliability of the consultation was assessed using Cronbach's α. After developing the app, a prospective randomized controlled study was conducted to evaluate the app's effect on participants' quality of life. The trial group used the app; the control group received a follow-up telephone consultation. Assessments of quality of life were conducted both at baseline and following a 4-week intervention period.

RESULTS

After two rounds of Delphi expert consultation, the functional modules of Pain Guardian were determined to include five functional modules, including pain self-measurement (real-time dynamic recording of pain by patients), patient reminders (reminders of outbreaks of pain disposal, medication, and review), uploading of examination reports, online consultation, health education, and other functional modules. Cronbach's α was 0.81. Overall, 96 patients (including esophageal, gastric, colorectal, nasopharyngeal, pulmonary, pancreatic, breast, ovarian, uterine, bone, thoracic, bladder, cervical, soft tissue sarcoma, mediastinal, and lymphoma) with cancer pain were divided into the trial and control groups. There were no significant differences in basic information and quality of life at baseline between groups. After 4 weeks of intervention, quality of life was significantly higher in the trial group than in the control group. Patients' satisfaction with the app was high (93.7%).

CONCLUSIONS

The primary obstacle encountered in the development of applications for managing cancer-related discomfort lies in the sensitive nature of the subject matter, potentially leading to patient apprehension regarding application usage for pain management. Consequently, meticulous attention to user preferences and anticipations is imperative, necessitating the creation of an application characterized by user-friendliness and medical efficacy.

TRIAL REGISTRATION

Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153 . Date of Registration: 2018-05-09.

The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy

BACKGROUND

Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents' well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue.

OBJECTIVE

This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations.

METHODS

We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted.

RESULTS

The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly.

CONCLUSIONS

This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources.

Does unequal economic development contribute to the inequitable distribution of healthcare resources? Evidence from China spanning 2001-2020

BACKGROUND

There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity.

METHODS

The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the β values of the samples.

RESULTS

The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all β < 0, P < 0.001). The long-term convergence rate of the geographic distribution of medical resources in China was higher than the short-term convergence rate (|βi + 1| > |βi|, i = 1, 2, 3, …, 9, all β < 0, P < 0.001), and the convergence speed of doctor density exceeded that of bed density (bed: |βi| >doc: |βi|, i = 3, 4, 5, …, 10, P < 0.001). Economic growth significantly affected the convergence speed of medical resources, and this effect was nonlinear (doc: βi < 0, i = 1, 2, 3, …, 9, P < 0.05; bed: βi < 0, i = 1, 2, 3, …, 10, P < 0.01). The heterogeneity between provinces had a notable impact on the convergence of medical resources.

CONCLUSIONS

The experiences of China have provided significant insights for nations worldwide. Governments and institutions in all countries worldwide, should actively undertake measures to actively reduce health inequalities. This includes enhancing healthcare standards in impoverished regions, addressing issues of unequal distribution, and emphasizing the examination of social determinants of health within the domain of public health research.

Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study

BACKGROUND

Limited studies have examined the benefits of early arthroplasty within 48 h from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, the authors aimed to investigate the trends in early arthroplasty within 48 h for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns.

MATERIALS AND METHODS

This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications [i.e. in-hospital death, pulmonary embolism, deep vein thrombosis (DVT), wound infection, and blood transfusion], rates and causes of 30-day readmission between early and delayed arthroplasty.

RESULTS

During the study period, the rate of early THA increased from 18.0 to 19.9%, and the rate of early HA increased from 14.7 to 18.4% ( P <0.001). After matching, 11 731 pairs receiving THA and 13 568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of pulmonary embolism [odds ratio (OR) 0.51, 95% CI: 0.30-0.88], DVT (OR 0.59, 95% CI: 0.50-0.70), blood transfusion (OR 0.62, 95% CI: 0.55-0.70), 30-day readmission (OR 0.82, 95% CI: 0.70-0.95), and venous thromboembolism-related readmission (OR 0.50, 95% CI: 0.34-0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI: 0.61-0.80) and blood transfusion (OR 0.74, 95% CI: 0.68-0.81) than delayed HA.

CONCLUSION

Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.

Incentive policy for the comprehensive development of young medical talents: an evolutionary game study

Introduction

Currently in China, there is a lack of well-defined and viable incentive mechanisms at the governmental and hospital levels to support the development of young medical talents, thereby hindering their growth Existing studies primarily investigate the current state and trajectory of incentives, yet they inadequately address the distinctive characteristics of various stakeholders involved in medical talent incentive processes, particularly the lack of research on incentive mechanisms with Chinese attributes.

Methods

This study adopts evolutionary game theory to investigate the dynamics of replication and the strategies for achieving evolutionary stability in the comprehensive development of young medical talents, considering both scenarios with and without supportive policies.

Results

In the absence of any supportive policy measures, the evolutionarily stable strategy (ESS) point is O(0,0), the unstable equilibrium point is C(1,1), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point C(1,1), which means that the young medical talents and medical institutions adopt a combination of strategies (actively seeking comprehensive development and taking incentive measures). Under the scenario with supportive policies, the ESS point is C(1,1), the unstable equilibrium point is O(0,0), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point O(0,0), which means that young medical talents and medical institutions adopt (N,N) strategy combinations (inactively seeking comprehensive development, implementing no incentive measure).

Discussion

(1) Government incentives play a crucial role in motivating young medical talents to seek comprehensive development. (2) The level of government incentive support for young medical talents should exceed the cost increment of individual efforts. Additionally, the policy support provided by the government to medical institutions should surpass the incentive support offered by these institutions to young medical talents. This will enhance the motivation and encouragement efforts of medical institutions in actively promoting comprehensive development among young medical talents. (3) With the backing of certain government incentive policies, medical institutions implementing incentive measures and young medical talents actively seeking comprehensive development will establish a virtuous cycle of mutual promotion.

Diagnostic Performance of Modified Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Patients Without Risk Factors for Hepatocellular Carcinoma: Comparison With World Federation for Ultrasound in Medicine and Biology Guideline

OBJECTIVE

The aim of this study was to assess the ability of the modified contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) to distinguish malignancy in patients without known hepatocellular carcinoma (HCC) risk factors and compare diagnostic accuracy with that of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guideline across radiologists with different levels of CEUS experience.

METHODS

A total of 848 individuals with no hepatitis infection presenting with 870 lesions in non-cirrhotic livers were included and divided into the Testing and Validation groups. The modified CEUS LI-RADS was proposed, including downgrading of focal nodular hyperplasia with typical features. Diagnostic performance of the modified CEUS LI-RADS was assessed in the Testing group. In the Validation group, two radiologists with more than 9 y of CEUS experience (Experts) and two radiologists with less than 6 mo of CEUS experience (Novices) used both the modified CEUS LI-RADS and the WFUMB guideline to evaluate performance in diagnosis of the lesions.

RESULTS

LR-5 + M (combination of modified LR-5 and modified LR-M) revealed optimal performance with a sensitivity, specificity and area under the curve (AUC) of 99.3%, 81.6% and 0.904, respectively. Novices using the modified CEUS LI-RADS outperformed those using the WFUMB guideline (AUC: 0.858 vs. 0.767, p = 0.005). Additionally, the sensitivity, specificity and AUC of Novices were comparable to those of Experts using the modified CEUS LI-RADS (94.1%, 77.6% and 0.858 vs. 96.1%, 77.6% and 0.868 for experts, respectively).

CONCLUSION

The modified CEUS LI-RADS is a valuable method for distinguishing hepatic malignancy in patients without HCC risk factors. This is particularly beneficial for radiologists with limited CEUS expertise.

Projections of future life expectancy in China up to 2035: a modelling study

BACKGROUND

To plan social and health services, future life expectancy projections are needed. The aim of this study was to forecast the future life expectancy for mainland China and its provinces.

METHODS

Following the same approach as the Global Burden of Disease Study, we used the largest compiled epidemiological and demographic datasets to estimate age-specific mortality and evaluate population data from 1990 to 2019. A total of 21 life expectancy forecasting models were combined by a probabilistic Bayesian model to forecast the life expectancy for mainland China and its provinces in 2035.

FINDINGS

The projected life expectancy at birth in mainland China in 2035 is 81·3 years (95% credible interval 79·2-85·0), and there is a high probability that the national goals of improving life expectancy will be achieved (79 years in 2030, and over 80 years in 2035). At the provincial level, women in Beijing have the highest projected life expectancy in 2035 with an 81% probability of reaching 90 years, followed by Guangdong, Zhejiang, and Shanghai, which all have more than a 50% probability of surpassing 90 years. Men in Shanghai are projected to have the highest life expectancy at birth in 2035, with a 77% probability of life expectancy being over 83 years, the highest provincial life expectancy in mainland China in 2019. The projected gains in life expectancy are mainly derived from older individuals (aged ≥65 years), except those in Xinjiang, Tibet, and Qinghai (for men), in which the main contributions come from younger (0-29 years) or middle-aged (30-64 years) individuals.

INTERPRETATION

Life expectancy in mainland China and its provinces has a high probability of continuing to increase through to 2035. Adequate policy planning of social and health services will be needed.

FUNDING

China National Natural Science Foundation and Social Science Fund of Jiangsu Province.

The application of artificial intelligence in health financing: a scoping review

INTRODUCTION

Artificial Intelligence (AI) represents a significant advancement in technology, and it is crucial for policymakers to incorporate AI thinking into policies and to fully explore, analyze and utilize massive data and conduct AI-related policies. AI has the potential to optimize healthcare financing systems. This study provides an overview of the AI application domains in healthcare financing.

METHOD

We conducted a scoping review in six steps: formulating research questions, identifying relevant studies by conducting a comprehensive literature search using appropriate keywords, screening titles and abstracts for relevance, reviewing full texts of relevant articles, charting extracted data, and compiling and summarizing findings. Specifically, the research question sought to identify the applications of artificial intelligence in health financing supported by the published literature and explore potential future applications. PubMed, Scopus, and Web of Science databases were searched between 2000 and 2023.

RESULTS

We discovered that AI has a significant impact on various aspects of health financing, such as governance, revenue raising, pooling, and strategic purchasing. We provide evidence-based recommendations for establishing and improving the health financing system based on AI.

CONCLUSIONS

To ensure that vulnerable groups face minimum challenges and benefit from improved health financing, we urge national and international institutions worldwide to use and adopt AI tools and applications.

National and subnational incidence, mortality and associated factors of colorectal cancer in China: A systematic analysis and modelling study

Background

Due to their known variation by geography and economic development, we aimed to evaluate the incidence and mortality of colorectal cancer (CRC) in China over the past decades and identify factors associated with CRC among the Chinese population to provide targeted information on disease prevention.

Methods

We conducted a systemic review and meta-analysis of epidemiolocal studies on the incidence, mortality, and associated factors of CRC among the Chinese population, extracting and synthesising data from eligible studies retrieved from seven global and Chinese databases. We pooled age-standardised incidence rates (ASIRs) and mortality rates (ASMRs) for each province, subregion, and the whole of China, and applied a joinpoint regression model and annual per cent changes (APCs) to estimate the trends of CRC incidence and mortality. We conducted random-effects meta-analyses to assess the effect estimates of identified associated risk factors.

Results

We included 493 articles; 271 provided data on CRC incidence or mortality, and 222 on associated risk factors. Overall, the ASIR of CRC in China increased from 2.75 to 19.39 (per 100 000 person-years) between 1972 and 2019 with a slowed-down growth rate (APC1 = 5.75, APC2 = 0.42), while the ASMR of CRC decreased from 12.00 to 7.95 (per 100 000 person-years) between 1974 and 2020 with a slight downward trend (APC = -0.89). We analysed 62 risk factors with synthesized data; 16 belonging to the categories of anthropometrics factors, lifestyle factors, dietary factors, personal histories and mental health conditions were graded to be associated with CRC risk among the Chinese population in the meta-analysis limited to the high-quality studies.

Conclusions

We found substantial variation of CRC burden across regions and provinces of China and identified several associated risk factors for CRC, which could help to guide the formulation of targeted disease prevention and control strategies.

Registration

PROSPERO: CRD42022346558.

Examining coordination and equilibrium: an analysis of supply index and spatial evolution characteristics for older adult services in Zhejiang Province

Objective

This study aims to analyze the spatial distribution and dynamic evolution of older adult service supply in Zhejiang Province from 2010 to 2019. Additionally, this research seeks to propose an optimized resource allocation strategy for older adult care services, promoting regional fairness and coordinated development.

Methods

To evaluate the older adult service supply capacity, this research first constructed an evaluation index system based on the Chinese modernization development pattern. Then, an empirical analysis was carried out using a combination of the entropy-TOPSIS method, kernel density estimation, Markov chain analysis, Dagum Gini coefficient, and panel regression model.

Results

The results show an overall upward trend in the supply and service capacity of older adult care in the whole province. However, the spatial distribution of older adult service supply capacity in Zhejiang Province still exhibits a gradient effect, even in the most recent year of 2019. Furthermore, the supply capacity of older adult services shifted to a higher level in the whole province, and regions with high supply capacity had a positive spillover effect on adjacent regions. The overall difference in the older adult service supply capacity of the province showed a decreasing trend. The level of economic development, urbanization rate, transportation capacity, the level of opening up, and the proportion of employees in the tertiary industry had a significant impact on the supply capacity and spatial difference of older adult services.

Conclusion

From the findings, this study puts forth countermeasures and suggestions to optimize the spatial distribution of older adult care services. This includes giving full play to the regional spatial linkage effect, promoting new-type urbanization construction, upgrading the transportation network, and expanding the opening up of the industrial structure. By implementing these measures, a more equitable and coordinated older adult services system can be developed in Zhejiang Province.

Development and validation of a regression model with nomogram for difficult video laryngoscopy in Chinese population: a prospective, single-center, and nested case-control study

Background

Airway management failure is associated with increased perioperative morbidity and mortality. Airway-related complications can be significantly reduced if difficult laryngoscopy is predicted with high accuracy. Currently, there are no large-sample studies on difficult airway assessments in Chinese populations. An airway assessment model based on the Chinese population is urgently needed to guide airway rescue strategy.

Methods

This prospective nested case-control study took place in a tertiary hospital in Shanghai, China. Information on 10,549 patients was collected, and 8,375 patients were enrolled, including 7,676 patients who underwent successful laryngoscopy and 699 patients who underwent difficult laryngoscopy. The baseline characteristics, medical history, and bedside examinations were included as predictor variables. Laryngoscopy was defined as 'successful laryngoscopy' based on a Cormack-Lehane Grades of 1-2 and as 'difficult laryngoscopy' based on a Cormack-Lehane Grades of 3-4. A model was developed by incorporating risk factors and was presented in the form of a nomogram by univariate logistic regression, least absolute shrinkage and selection operator, and stepwise logistic regression. The main outcome measures were area under the curve (AUC), sensitivity, and specificity of the predictive model.

Result

The AUC value of the prediction model was 0.807 (95% confidence interval [CI]: 0.787-0.828), with a sensitivity of 0.730 (95% CI, 0.690-0.769) and a specificity of 0.730 (95% CI, 0.718-0.742) in the training set. The AUC value of the prediction model was 0.829 (95% CI, 0.800-0.857), with a sensitivity of 0.784 (95% CI, 0.73-0.838) and a specificity of 0.722 (95% CI, 0.704-0.740) in the validation set.

Conclusion

Our model had accurate predictive performance, good clinical utility, and good robustness for difficult laryngoscopy in the Chinese population.

Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China

The hierarchical diagnosis and treatment reform of China can guide residents to seek medical treatment in an orderly manner and improve access to medical treatment. Most existing studies on hierarchical diagnosis and treatment used accessibility as the evaluation index to determine the referral rate between hospitals. However, the blind pursuit of accessibility will cause the problem of uneven utilization efficiency of hospitals at different levels. In response to this, we constructed a bi-objective optimization model based on the perspective of residents and medical institutions. This model can give the optimal referral rate for each province considering the accessibility of residents and the utilization efficiency of hospitals, to improve the utilization efficiency and equality of access for hospitals. The results showed that the applicability of bi-objective optimization model is good, and the optimal referral rate based on the model can ensure the maximum benefit of the two optimization goals. In the optimal referral rate model, residents' medical accessibility is relatively balanced overall. In terms of obtaining high-grade medical resources, the accessibility is better in the eastern and central regions, but poorer in the western China. According to the current allocation of medical resources in China, the medical tasks undertaken by high-grade hospitals account for 60%-78%, which are still the main force of medical services. In this way, there is a big gap in realizing the "serious diseases do not leave the county" goal of hierarchical diagnosis and treatment reform.

The epidemiological characteristics of neurogenic limb deformity disorder in China: a national-based study from Qin Sihe orthopedic center

BACKGROUND

Neurogenic limb deformity disorder (NLDD) refers to limb deformity disorders caused by various neurogenic disorders. However, there are no studies to systematically summarize and analyze these diseases in China, and we first proposed the concept of NLDD. We describe the epidemiological characteristics of NLDD in China based on the largest case database of limb orthopedics in China.

METHODS

This study analyzed parameters from the Qin Sihe Orthopedic Surgery Case Data (QSHOSCD). The database is based on the Rehabilitation Hospital affiliated to National Research Center for Rehabilitation, which has collected nearly 37,000 patients to date and includes a wide variety of limb deformities. The types of diseases are summarized and classified for all patients studied. Statistical analysis was based on the type of etiology, age, regional distribution, and historical surgical volume. Partial outcomes were statistically analyzed separately by common diseases (polio and cerebral palsy) and rare diseases (37 other diseases).

RESULTS

From 1979 to 2019, 30,194 patients with NLDD were treated surgically for 39 neurogenic disorders. The male to female ratio was 1.48:1, the mean age was 19.65 years, and most patients (82.38%) were aged between 6 and 30 years. Patients included from 32 provinces and cities across China, mainly concentrated in populous central provinces and Heilongjiang Province. The peak of annual surgical procedures was from 1988 to 1994, and the number of annual surgical procedures for common diseases gradually decreased from 1994 onwards, but the trending is opposite for rare diseases.

CONCLUSIONS

This study is the first to demonstrate the disease types, population characteristics and incidence trends of NLDD in China. It suggests that the prevention and treatment of NLDD should focus on the adolescent population and enhance the treatment of neurogenic diseases that cause limb deformities. The growth and adaption of the Ilizarov technique and its practice in Chinese orthopedic benefits the treatment of neurogenic limb deformity disorders.

Exacerbation in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

BACKGROUND

Chronic obstructive pulmonary disease (COPD) management in China is inadequate and there is a need to improve care and outcomes for patients nationwide.

OBJECTIVES

The REAL study was designed to generate reliable information on COPD management from a representative sample of Chinese patients with COPD. Here, we present study outcomes related to acute exacerbations.

DESIGN

A 52-week, multicentre, prospective, observational study.

METHODS

Outpatients (aged ⩾ 40 years) enrolled from 25 tertiary and 25 secondary hospitals across six geographic regions in China were followed for 12 months. Risk factors for COPD exacerbation and disease severity by exacerbation were assessed using multivariate Poisson and ordinal logistic regression models, respectively.

RESULTS

Between June 2017 and January 2019, 5013 patients were enrolled, with 4978 included in the analysis. Mean (standard deviation) age was 66.2 (8.9) years. More patients presented with exacerbations in secondary versus tertiary hospitals (59.4% versus 40.2%) and in rural versus urban areas (53.2% versus 46.3%). Overall exacerbation rates differed across regions (range: 0.27-0.84). Patients from secondary versus tertiary hospitals had higher rates of overall exacerbation (0.66 versus 0.47), severe exacerbation (0.44 versus 0.18) and exacerbation that resulted in hospitalisation (0.41 versus 0.16). Across regions and hospital tiers, the rates of overall exacerbation and exacerbations that resulted in hospitalisation were highest in patients with very severe COPD (based on the severity of airflow limitation or GOLD 2017 combined assessment). Strong predictors of exacerbation included demographic and clinical characteristics, modified Medical Research Council scores, mucus purulence, exacerbation history and the use of maintenance mucolytic treatment.

CONCLUSION

COPD exacerbation rates varied across regions and were higher in secondary compared with tertiary hospitals in China. Understanding the factors associated with COPD exacerbation may facilitate improved management of COPD exacerbations in China.

REGISTRATION

The trial was registered on 20 March 2017 (ClinicalTrials.gov: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362).

PLAIN LANGUAGE SUMMARY

Exacerbations in patients with chronic obstructive pulmonary disease in ChinaBackground: Chronic obstructive pulmonary disease (COPD) causes progressive and irreversible airflow limitation. As the disease progresses, patients often experience a flare up of symptoms referred to as an exacerbation. There is inadequate management of COPD in China and, therefore, there is a need to improve care and outcomes for patients across the country.Objective: This study aimed to generate reliable information on exacerbations among Chinese patients with COPD to help inform future management strategies.Study design and methods: Patients (aged ⩾ 40 years) were enrolled from 25 secondary and 25 tertiary hospitals across six regions of China. Physicians collected data over 1 year during routine outpatient visits.Results: There were more patients who experienced an exacerbation in secondary versus tertiary hospitals (59% versus 40%) and in rural versus urban areas (53% versus 46%). Patients in different geographic regions experienced varying frequencies of exacerbations over 1 year. Compared with patients from tertiary hospitals, patients from secondary hospitals experienced exacerbations (including exacerbations that were severe and those that resulted in hospitalisation) at a higher frequency over 1 year. Patients with very severe disease experienced exacerbations (including exacerbations that resulted in hospitalisation) at the highest frequency over 1 year, regardless of the patient's geographic region or hospital tier. Patients who had certain characteristics and symptoms, had exacerbation(s) over the previous year, or received medication that aids in the clearance of mucus were more likely to experience exacerbations.Conclusion: The frequency of exacerbations among Chinese patients with COPD varied between patients living in different geographic regions and between patients presenting to different hospital tiers. Understanding the factors related to the occurrence of an exacerbation may help physicians better manage the disease.

Seeking policy solutions in a complex system: experimentalist governance in China's healthcare reform

The proliferation of "wicked" policy problems in complex systems requires an experimental approach of problem-solving. Experimentalist governance offers a conducive framework through which to seek policy solutions amidst high levels of complexity in a multilevel governance structure. This study conceptualizes four distinctive experimental modalities based on varying levels of technical complexity and interest complexity, both of which represent salient constraints for policy reforms in a complex system, the health sector in particular. Trail-blazing pilots, crowdsourcing pilots, managed pilots, and road-testing pilots are all associated with distinct mechanisms of experimentation in a multilevel governance structure. Through four illustrative cases from China's massive experimental program of public hospital reform, this study demonstrates how experimentalist governance seeks policy solutions in the health sector. Should governance arrangements, policy capacity, pragmatism, and informational devices become aligned in a conducive way, experimentalist governance can play an instrumental role in seeking solutions for difficult problems in a complex policy system. A governance structure capable of policy learning and adaptive management is the key.

Incorporating Exercise Efficiency to Evaluate the Accessibility and Capacity of Medical Resources in Tibet, China

Accessibility and capacity of medical resources are key for the health care and emergency response, while the efficiency of the medical resources is very much limited by hypoxia in Tibet, China. Through introducing exercise efficiency, this study explores the accessibility of township residence to county-ship medical resources in Tibet using weighted mean travel time (WMT), and evaluates the medical capacity accordingly. The results show that: 1) the average travel time of township residence to county-level hospital is around 2 h by motor vehicle in Tibet. More than half of the population can not reach the county-ship hospital within 1 h, 33.24% of the population can not reach within 2 h, and 3.75% of the population can not reach within 6 h. 2) When considering the catchment of the medical resources and the population size, the WMT of the county-ship medical resources ranges from 0.25 h to 10.92 h. 3) After adjusted by travel time and exercise efficiency, the county-ship medical capacity became more unequal, with 38 out of 74 counties could not meet the national guideline of 1.8 medical beds per 1000. 4) In total, there are 17 counties with good WMT and sufficient medical resources, while 13 counties having very high WMT and low capacity of medical resources in Tibet. In the end, suggestions on medical resources relocation and to improve the capacity are provided. This study provides a method to incorporate exercise efficiency to access the accessibility and evaluate medical capacity that can be applied in high altitude ranges.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11769-022-1321-1.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010-2019

Background

The maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect.

Methods

The health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N.

Results

Global Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N.

Conclusion

There were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.

Understanding China's urban system evolution from web search index data

The spatial inequilibrium phenomenon is apparent during China's rapid urbanization in the past four decades. As the fertility rate decreases and the population ages, this phenomenon will become more critical. To accurately forecast the future economic development of China, it is necessary to quantify the attractiveness of individual cities. This study introduces web search data to quantify the attractiveness of cities with a fine spatial scale (prefecture-level city) and relatively long-term span (nine years). Results confirm that the estimated city attractiveness can unravel a city's capability to attract labor force, and suggest that tourism and health care functions of a city have a positive effect to the city's attractiveness. Additionally, China's north-south gap in economic development has been widened in the past decade, and 11 cities with nationwide influence have prosperous development potential. This study provides a new lens for predicting China's economic development, as well as its spatial patterns.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1140/epjds/s13688-022-00332-y.