The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China

Antimicrobial stewardship interventions in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis evaluate the effectiveness of ASPs in managing community-acquired pneumonia (CAP), focusing on antibiotic optimization and resistance mitigation.

METHODS

Comprehensive literature searches were conducted in PubMed, Scopus, and Web of Science using PICOS criteria. Studies involving adults with CAP exposed to ASPs were included. Data on clinical, economic, diagnostic, and treatment outcomes were extracted. Random-effects meta-analysis using R software pooled effect sizes. Outcomes reported in at least three studies were analyzed for robustness.

RESULTS

ASPs did not significantly impact in-hospital mortality, length of stay, 30-day readmissions, sample collection rates, or intravenous antibiotic duration. However, notable improvements included shorter time to clinical stability and a 31% reduction in 30-day mortality. Legionella urinary antigen testing frequency increased nearly threefold, and the time from admission to antibiotic initiation was reduced. Enhanced adherence to timely antibiotic administration and recommended regimens was observed, though outcome variability persisted.

CONCLUSION

ASPs significantly improve CAP management by enhancing clinical stability and accelerating antibiotic initiation. Multifaceted strategies, including rapid diagnostics and clinician education, yield clinical benefits. However, outcome variability suggests a need for tailored interventions. Future research should isolate specific ASP components influencing prescriber behavior. Ongoing investment in education, diagnostics, and interdisciplinary collaboration is vital to optimize CAP treatment and combat antibiotic resistance.

Sanming Model of Medical Service Integration: Impact on Medical Expenditures, Service Provision, and Resource Allocation in China

Background

Fragmentation of healthcare services has been a central issue, contributing to escalating medical expenditures and service provision, thereby exacerbating the waste of limited medical resources. In response, China has introduced the Sanming Mode, a medical service integration model designed to address these challenges. This study evaluates the model's impact on medical expenditures, service provision, and resource allocation.

Methods

We conducted an interrupted time series analysis on outcome variables related to medical expenditures, service provision, and resource allocation in Sanming City. The dataset encompassed operational data from all public hospitals and community health service institutions in Sanming from January 2016 to November 2019.

Results

Post-reform, the monthly medical expenditures, outpatient visits, and inpatient admissions in Sanming City shifted from a rapid growth trend to a slower growth trend, with slopes decreasing by 0.1%, 1.4%, and 0.5%, respectively. Heterogeneity analysis between hospitals and community health service institutions revealed a more pronounced slowdown in the growth rate of monthly medical expenses in community health service institutions. However, the growth rates for outpatient and inpatient visits in hospitals significantly decreased post-reform, while there was no significant change observed in community health service institutions.

Conclusion

The Sanming Model represents a significant localized attempt to integrate hospital and community health services in China. It effectively curbs the rapid growth of medical expenditures and service provision, thereby reducing the consumption of basic medical insurance funds. The Model enhances the efficiency of medical resource utilization and promotes a shift in service provision from hospitals to community health service institutions, reflecting a trend in resource allocation that concentrates serious illnesses in hospitals while directing minor health issues to community health service institutions. This positive impact promotes the effective integration and rational allocation of medical resources.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

Objectives

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.

Methods

An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.

Results

After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).

Conclusion

The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019

Background

The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China.

Methods

We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness.

Findings

Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected.

Interpretation

Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China.

Funding

This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].

Successes and challenges of China's health care reform: a four-decade perspective spanning 1985-2023

Chinese health system remains the crucial one for understanding the wider healthcare landscape across the Global South and in particular the leading Emerging Markets. Purpose of our observation was to understand the inner dynamics of mainland Chinese health reforms adopting a lengthy time horizon. We have analysed the public reports and seminal evidence on Chinese of multiple waves of national health reforms taking place since 1980s in terms of medical care and pharmaceuticals provision and financing. Chinese international trade with ASEAN nations and wider South-East Asia is accelerating its growth after the recovery of trade routes. In terms of health sector this means that global demand and supply of medical goods, services and pharmaceuticals remains largely driven by Chinese domestic developments. Furthermore, Chinese domestic manufacturing and sales of decent quality medical devices and services have grown exponentially. Some temporary pitfalls and increasing in rural-urban inequalities in equity of access and affordability of medical care and pharmaceuticals did take place. Despite these difficulties to generate a balanced development strategy for the largest global market, this is a clear path upwards. Further upcoming improvements expanding health insurance coverage are in strong demand for certain layers of the society. Domestic bottleneck weaknesses yet remain manufacturing, import and market penetration of cutting-edge pharmaceuticals such as monoclonal antibodies and targeted oncology agents. Yet some of these obstacles are likely to be overcome in foreseeable future with the adoption of responsible strategies by governmental agencies in health care arena.

Influence of public hospital reform on public health: Evidence from a quasi-natural experiment in China

Public health is an important symbol of national wealth and prosperity. At present, China's public health is hindered by the poor management of public hospitals, which impacts the demographic structure and socioeconomic development. Therefore, taking the implementation of public hospital reform in China as a quasi-natural experiment, this study employed the time-varying DID model and the mediating effect to evaluate the influence of public hospital reform on public health. The results were as follows: (1) Public hospital reform can significantly improve public health, and a series of robustness tests have also confirmed the effects; (2) Government's financial support is a transmission mechanism for public hospital reform to promote public health; (3) After taking control variables into consideration, the effect of public hospital reform is stronger in the western region with a poorer economy. This research provides a vital policy reference for promoting the scope of reform and improving the health of the general public.