A Comprehensive Evaluation of China's TCM Medical Service System: An Empirical Research by Integrated Factor Analysis and TOPSIS

Unveiling spatial disparities in basic medical and health services: insights from China's provincial analysis

Based on the panel data of 31 provinces (municipalities and autonomous regions) in China from 2012 to 2019, this paper constructs the evaluation index system of basic medical and health services in China from seven dimensions: medical and health facilities, health expenditure, medical services, traditional Chinese medicine hospital services, maternal and child health care, people's health and medical security, disease control and public health. The entropy method was used to measure the level of basic medical and health services in China, and its spatial differences and convergence characteristics were further investigated. In this study, we employ the entropy weight method, σ convergence, and β convergence as our primary methodologies. The entropy weight method is used to evaluate the variability of each indicator, determine the weights of indicators, and quantify the information content of the data. σ convergence illustrates the process by which the variance of a sample decreases over time. β convergence refers to the gradual approach of variables within an economic system towards their long-term equilibrium level over time. The results show that: (1) The scores of basic medical and health services in China's four major regions (including Northeast, East, Central and West) remain in a relatively stable state, with small fluctuations and great room for improvement; (2) There are significant regional differences in the level of basic medical and health services in China, and the intra-regional differences are much greater than the inter-regional differences; (3) There is no significant σ convergence observed in China and its four major regions; however, there is a notable presence of β convergence.

Assessing evidence-based practice competencies of undergraduate nursing students using a developed multi-criteria decision-analysis model

AIM

The developed multi-criteria decision analysis model was used to identify the inter-influence relationships and key factors affecting the EBP competencies of UNSs, to assess the EBP competencies of UNSs and based on these results, to formulate an improvement strategy to enhance the EBP competencies of UNSs.

BACKGROUND

EBP is considered a core competency in international nursing practice. However, few studies have developed EBP evaluation models and applied them to assessing and improving the EBP competencies of UNSs.

DESIGN

This is a quantitative study with multi-criteria decision-analysis model.

METHODS

Firstly, the questionnaire was designed based on the characteristics of the DEMATEL and VIKOR-AS methods, which was completed by 17 nursing experts from a case hospital in Zhejiang Province, China. Subsequently, the DEMATEL method was used to analyze the inter-influence relationships among various criteria to determine their respective weights. Finally, the VIKOR method is utilized to integrate multiple criteria and their relative weights to assign comprehensive scores to each UNSs.

RESULTS

The use of the DEMATEL method reveals that "Knowledge (C1)", "Mastering the basic scientific research methods during the study of the undergraduate courses (C11)", "Being able to consult clinical experts appropriately when encountering problems in clinical practice (C23)" and "Understanding the importance of reading journals related to the nursing profession regularly (C34)" were critical influencing factors. "Skill (C2)," "Being able to explain the essential roles of the best research evidence in determining clinical practice (C15)," "Being able to apply the collected research evidence to the individual case in nursing care (C25)" and "Paying attention to using the evidence-based nursing practice concept to determine the best clinical practice (C35)" were the most influential factors. According to the VIKOR method, the performance of the UNSs in the case hospitals in terms of EBP competencies from highest to lowest was Student C, Student B and Student A. However, all of these students suffered from deficiencies at the knowledge level.

CONCLUSIONS

The application of the DEMATEL and VIKOR methods provides a systematic and comprehensive approach to the assessment of EBP competencies of UNSs. The lack of EBP competencies of UNSs in case hospitals is mainly reflected in knowledge level. To improve UNSs' EBP competencies, medical schools and hospital educators should propose short- and long-term strategies to improve knowledge.

Establishment and application of drug utilization evaluation applying the weighted TOPSIS method: A study based on real-world data of tislelizumab

BACKGROUND

How to comprehensively evaluate the rationality of drug use is a challenging issue.

OBJECTIVE

To establish the evaluation index of the effective use of tislelizumab, so as to ensure its higher rationality and normalization in clinical application.

METHODS

Based on the indications, drug instructions, and relevant guidelines of the National Basic Medical Insurance Restriction Catalogue, a retrospective analysis and evaluation of 286 cases of using tislelizumab injection in our hospital from January to December 2022 were conducted using the weighted technique for order of preference by similarity to ideal solution (TOPSIS) method.

RESULTS

Among the 286 medical records evaluated, the main irrational manifestations were inappropriate indications (90 cases, 31.47%), auxiliary examination and laboratory examination did not meet the minimum requirements of combination chemotherapy drugs (40 cases, 13.99%), the drug course was not standard (39 cases, 13.64%). Among the included cases, 57.34% were reasonable cases (Ci⩾ 0.8), 10.84% were basic reasonable cases (0.6 ⩽Ci< 0.8), and 31.82% were unreasonable cases (Ci< 0.6).

CONCLUSION

The TOPSIS method, with its attribute hierarchical model (AHM)-weighted approach, can be employed as the rational assessment technique for the injection of tislelizumab. The clinical application of tislelizumab in our hospital is still insufficient, which needs to be further improved management.

Medical service quality evaluation based on LDA and sentiment analysis: Examples of seven chronic diseases

Objective

In this article, we investigate how chronic noncommunicable disease (CND) patients evaluate the medical service, and what obstacles exist in this process, which is useful for hospitals to improve efficiency and enhance patient satisfaction.

Methods

Based on the total number of CND patients in China, 7 CNDs were selected as the evaluation objects, and then selected the Haodaifu website as the data source, crawled 15,682 medical service reviews, then the 9 themes were analyzed by the LDA theme model. The evaluation index system of six indicators was constructed based on quality management theory. The binary long short-term memory model was used to analyze the sentiment, and the entropy-valued, TOPSIS and gray correlation model was implemented for medical service quality evaluation; the barrier model was used to find out the key factors limiting medical services.

Results

(a) Hypertension was rated at a good level in the degree of gray correlation closeness, bronchitis was rated at a low level and the rest were at an intermediate level. (b) The first two overall barriers were the hospitalization process and registration services which occupy about 30%, respectively. This implies that hospitals should focus on providing registration services and inpatient settings in the future.

Conclusion

To promote hospitals to provide better services for patients with CNDs and improve patient satisfaction with medical care. And it is necessary to optimize medical services fundamentally by optimizing the inpatient process and improving the registration process to improve efficiency.

An International Comparative Study on the Resilience of Urban Communities after COVID-19 Pandemic: A One-Year Case Study between Lanzhou, China and Sarajevo, Bosnia and Herzegovina

After the prevailing of the COVID-19 pandemic, urban communities around the world took initiatives to bring their cities back to life. In this research, 45 indicators and 55 elements were selected to make comparisons between urban communities in Lanzhou, China and Sarajevo, Bosnia and Herzegovina from five dimensions of social resilience, economic resilience, institutional resilience, infrastructural resilience, and community capital resilience. At the same time, the ArcGIS platform tool was used for spatial interpolation analysis. In this paper, the inverse distance weighting (IDW) method was used to carry out the spatial analysis of the perceived resilience of the two cities. Due to the heterogeneity of the neighborhood physical environment, operation and management mode, individual attribute characteristics, and internal relations, the resilience of the two urban communities showed disparity in different dimensions. Overall, the communities with good urban property management services, high-income owners, and the convenient transportation have stronger resilience in the face of pandemic. On the contrary, scattered communities, which are scattered in the inner cities, lack effective management, and based on unstable employment, people become the most affected by the epidemic with the lowest resilience power. The importance of social capital, represented by community understanding, identity, and mutual help and cooperation between neighbors, is highlighted in the resilience assessment of the two cities, respectively, in the East and West, indicating that to build more resilient cities, in addition to improving government management and increasing investment in urban infrastructure, building the residents' sense of belonging, identity, and enduring community culture is even more important in the construction of resilient cities.

Research on the equity of health resource allocation in TCM hospitals in China based on the Gini coefficient and agglomeration degree: 2009-2018

Background

The demographical and geographical distributions of health resources are important aspects of healthcare access. Few studies have been published on health resource allocation in TCM hospitals in China despite public equity concerns.

Methods

This article uses the Gini coefficient and agglomeration degree to analyze the health resources of TCM hospitals in China according to demographic and geographic configuration conditions in order to study the equity of the health resources of TCM from 2009 to 2018.

Results

From 2009 to 2018, all regions of the TCM health resources per ten thousand people and per ten thousand square kilometers showed overall upward trends. The overall equity of the health resource allocations of TCM hospitals in China tended to improve year by year. However, there were still great differences among regions. Generally, the equity of physical resource allocation was better than the equity of human resource allocation. Additionally, the equity of health resources in TCM hospitals allocated by population was better than it was by geographic region.

Conclusions

It is necessary to further optimize the structure of TCM resource allocation, and enhance the equity of resource allocation among different regions.

The know-do gap in quality of health for chronic non-communicable diseases in rural China

Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the "know-do gap" between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.

Sustainable Health and Wellbeing in the European Union

Background

Altogether, 17 Sustainable Development Goals (SDGs) are an urgent call for action to end poverty, protect the planet, and ensure prosperity for all. Goal 3 is crucial in terms of good health and wellbeing. The main aim of this study is to analyze and evaluate differences among indicators of SDG 3: Sustainable health and wellbeing in the EU countries.

Methods

The status and development of the EU Member States regarding their successes or failures in terms of Goal 3 were subjected to analysis. Altogether, 11 indicators were used to rank the EU countries using the TOPSIS and ranking methods. The ranks were assigned to the countries in two periods. The first period is related to the time from 2010 till 2014, and the second period from 2015 till 2019.

Results

The EU countries achieved a positive development in 10 of 11 indicators that monitor the achievement of the EU in terms of Goal 3. The only variable that changed negatively was the obesity rate. Positivity was observed in the decline of the standardized preventable and treatable mortality, which declined from 317.3 in the first period to 295 in the second period; the drop of the population weighted annual mean concentration of fine particulate PM2.5, from 16.4 to 13.6 μg/m³, and also in the increase of the share of people with good or very good perceived health, which was combined with a decrease of the self-reported unmet need for medical examination and care. The best-rated country in terms of SDG 3 was, in both periods, Sweden, while the worst-rated was Latvia.

Conclusions

Governments and institutions in the EU can intervene to increase the accessibility and quality of the health care system, but every citizen should try to do their best to reduce some of the risk factors, such as smoking or obesity, to try living healthier and to help to achieve higher ambitions in terms of sustainable health and wellbeing.

Similarities and differences between China and Sweden regarding the core features of palliative care for people aged 60 or older: a systematic scoping review

Background

Despite the increasing longevity of the world’s population, with an unprecedented rise in the number of people who need palliative care (PC), there has been sparse research regarding palliative care for older people, especially when it comes to comparison of PC between healthcare systems and cultures. The aim of this systematic scoping review was to identify the characteristics of the body of literature and to examine the knowledge gaps concerning PC research for older people (> 60 years) in two healthcare systems and cultures, mainland China and Sweden.

Methods

The guidelines PRISMA (Preferred Reporting Items for Systematic Reviews), and PICOS (Patient/population, Intervention, Comparison/control, and Outcome) were used. Empirical studies on patients 60 years or older, next of kin or staff participating in a palliative care intervention or setting were included. They were conducted in mainland China or in Sweden during 2007–2019, were published in English and were extracted from seven databases: Embase, PubMed, Scopus, Cinahl, PsycInfo, Academic Search Complete and Cochrane Library. Two independent researchers conducted the selection of studies, data extraction and methodological evaluation. Any disagreements were resolved in consultation with a third researcher. The analysis was manifest directed content analysis based on PICOS domains.

Results

Of the 15 studies, four were from mainland China and 11 from Sweden. Both countries included older patients with cancer but also other end-stage diseases such as heart failure and dementia. The studies differed in design, method and the content of the interventions. The study in China based on traditional Chinese medicine concerns traditional Chinese folk music. The six qualitative studies from Sweden were evaluations of five interventions.

Conclusions

Despite the high age of the participating patients, there was no focus on an ageing perspective concerning palliative care. To adapt to the changes taking place in most societies, future research should have increased focus on older persons’ need for palliative care and should take account of issues concerning research ethics, ethnicity and culture.

Registered in Prospero

CRD42020078685, available from.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00906-7.

Configuration Analysis of Influencing Factors of Technical Efficiency Based on DEA and fsQCA: Evidence from China's Medical and Health Institutions

Purpose

This paper aims to measure the technical efficiency of China’s medical and health institutions from 2012 to 2017 and outline the path to achieve high-quality development.

Methods

The DEA-Malmquist was used to evaluate the total factor productivity of medical and health institutions in 31 provinces. A fuzzy set Qualitative Comparative Analysis (fsQCA) was used for configuration analysis of determinants affecting technical efficiency.

Results

The average total factor productivity (TFP) of those institutions was 0.965, namely TFP declined averagely by 3.5% annually. The efficiency change and the technical change were 0.998 and 0.967, respectively. The realization paths of high technical efficiency are composed of high fatality rate and high financial allocation-led, high population density and high GDP-led. Low dependency ratio and low financial allocation-led, low fatality rate and low financial allocation-led are the main reasons for low technical efficiency.

Conclusion

Due to advanced medical technology and economic development, major cities like Beijing, Shanghai, and Guangdong have attracted a large number of high-level health personnel, achieving long-term and stable health business growth. Hubei, Anhui, and Sichuan also have made rapid development of health care through appropriate financial subsidies and policy supports. The technical changes in Qinghai, Yunnan, and Inner Mongolia are higher than the national average, but the operation and management level of the medical and health institutions is relatively weak. Henan, Jiangxi, and Heilongjiang have a prominent performance in the efficiency change, but the technical change is weaker than the national average.