Measuring Productivity and Relative Efficiency of Public Tertiary Traditional Chinese Medicine Hospitals in Hubei, China

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

The Efficiency Evaluation of Municipal-Level Traditional Chinese Medicine Hospitals Using Data Envelopment Analysis After the Implementation of Hierarchical Medical Treatment Policy in Gansu Province, China

Background: Efficiency evaluation is an integral part of new medical reform and is necessary to solve the problem of limited and unbalanced medical resources. This study evaluated the efficiency of municipal-level Traditional Chinese Medicine hospitals by Data Envelopment Analysis application after a hierarchical medical treatment policy was implemented. We propose solutions to the problems existing in hospital operations and promote the utilization efficiency of medical resources in those hospitals. Methods: The sample included all municipal-level TCM hospitals in Gansu province from 2017 to 2019. The DEA-BCC model was employed to evaluate the relative efficiency of hospital operations, and the Manny-Whitney test was used to compare the input and output variables of technical efficiency efficient and inefficient hospitals. Results: From 2017 to 2019, the growth in the number of staff in secondary hospitals (25.88%) was lower than that in tertiary hospitals (31.98%). However, the increase in the number of beds (16.52%) in secondary hospitals was higher than that in tertiary hospitals (−0.30%). 5 (38.46%) achieved DEA efficient in secondary hospitals and 2 (40.00%) in tertiary hospitals. The means of technical efficiency, pure technical efficiency, and scale efficiency in secondary hospitals were 0.812, 0.887, and 0.908, respectively. The means in tertiary hospitals were 0.868, 0.926, and 0.935, respectively. The hospital areas were statistically different between the TE efficient and inefficient hospitals (P<0.05) in secondary hospitals. However, the number of outpatients between the two groups was statistically different (P<0.05) in tertiary hospitals. Conclusion: In this study, the medical and health services of municipal TCM hospitals in Gansu Province have made great progress. Due to the backward economy of Gansu Province, the classification of diagnosis and treatment of diseases was still based on Western medicine, resulting in the slow medical development of some municipal TCM hospitals. TCM hospitals should improve management efficiency, optimize hospital operation scale, improve the utilization efficiency of medical resources and promote efficient hospital development.

Epidemiology of Sepsis-Associated Acute Kidney Injury in Beijing, China: A Descriptive Analysis

Background

Sepsis is the most common contributing factor towards development of acute kidney injury (AKI), which is strongly associated to poor prognostic outcomes. There are numerous epidemiological studies about sepsis-associated acute kidney injury (S-AKI), however current literature is limited with the majority of studies being conducted only in the intensive care unit (ICU) setting. The aim of this study was to assess the epidemiology of S-AKI in all hospitalized in-patients.

Methods

This was a retrospective population-based study using a large regional population database in Beijing city from January, 2005 to December, 2017. It included patients with S-AKI. Patients with pre-existing end-stage kidney disease (ESKD), previous history of kidney transplantation, or being pregnant were excluded. Patients’ demographic characteristics, incidence, risk factors and outcomes of S-AKI were analyzed. The contrast between different time periods, different levels of hospitals, and types of the hospitals (traditional Chinese medicine hospitals (TCMHs) and western medicine hospitals (WMHs)) was also compared using Mann–Whitney U-test.

Results

A total of 19,579 patients were included. The overall incidence of S-AKI in all in-patients was 48.1%. The significant risk factors by multivariate analysis for AKI included: age, male, being treated in a level-II hospital, pre-existing hypertension, chronic kidney disease (CKD), cirrhosis, atrial fibrillation (AF), ischemic heart disease (IHD), being admitted from emergency room, ICU admission, shock, pneumonia, intra-abdominal infection, bloodstream infection, respiratory insufficiency, acute liver injury, disseminated intravascular coagulation (DIC) and metabolic encephalopathy. The overall mortality rate in this cohort was 55%. The multivariate analysis showed that the significant risk factors for mortality included: age, being treated in a level-II hospital and TCMHs, being admitted from emergency room, pre-existing comorbidities (CKD, malignancy, cirrhosis and AF), shock, pneumonia, intra-abdominal infection, bloodstream infection, central nervous system (CNS) infection and respiratory insufficiency.

Conclusion

AKI is a common complication in patients with sepsis, and its incidence increases over time, especially when ICU admission is required. Exploring interventional strategies to address modifiable risk factors will be important to reduce incidence and mortality of S-AKI.