Dataset Information

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China.

ABSTRACT: There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, which were sampled from 6 county hospitals in 3 counties of eastern China. The average proportion of recommended care delivered included stroke, pneumonia, and heart failure patients at 55.36%, 41.64%, and 49.56%, respectively. Great variation of QoC was detected not only across selected counties but between comprehensive county hospitals and traditional Chinese medicine county hospitals. We deny the widely-accepted assumptions that poor QoC should be blamed on defectively-equipped facilities or medicine and overwhelmed care providers. Instead, we speculate the low qualifications of medical workers, failed clinical knowledge translation, incorrect diagnosis, and a lack of electronic systems could be the reasons behind poor QoC. It is high time for China to put QoC as the national health priority.

SUBMITTER: Wang Q

PROVIDER: S-EPMC9332810 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China.

Wang Quan Q Yang Li L Chen Jialin J Tu Xi X Sun Qiang Q Li Hui H

International journal of environmental research and public health 20220727 15

There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, whic ...[more]

PMID: 35897514

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Project description:BackgroundAdherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients' quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021.MethodsAn institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05.ResultsAdherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58-13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00-5.13), NYHA class III (AOR: 7.01, 95% CI 2.18-22.57) and class IV (AOR: 6.30, 95% CI 1.01-39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64-21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56-9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05.ConclusionThis study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients.

Project description:ObjectivesPatient experience is being widely considered in the evaluation of healthcare service quality, which is a key target for public hospitals under China's New Healthcare Reform. This study aimed to illustrate patients' experiences in county-level public hospitals, and identify aspects that need to be improved.Setting and participantsBetween 2016 and 2018, a cross-sectional study with 500 outpatients and 800 inpatients was conducted in 10 county-level public hospitals from Shandong Province, Hubei Province and Chongqing Municipality.MethodA three-part questionnaire was used to evaluate patients' experiences during their visits to hospitals. It comprised a questionnaire for basic information, the Picker Patient Experience (PPE-15) Questionnaire and the overall evaluation (a 3-point Likert scale to express patients' satisfaction and patient loyalty). Patients' experiences were classified according to six dimensions (information transmission and patient education, respect for patient preference, emotional support, physical comfort, involvement of family or friends and continuity of medical service). Both univariate and multivariate analyses were performed to evaluate patient experience.ResultsA total of 1241 valid questionnaires were analysed. The mean PPE-15 score was 41.33 (range, 23-56). The better the patient experience and satisfaction, the higher the patient loyalty (p<0.001). Except for hospital disparities, patients' age and occupation status had a significant impact on patient experience (p<0.05). Of the six dimensions, the physical comfort score was the highest, while the respect for patient preference score was the lowest. Additionally, a strong correlation was found between the respect for patient preference dimension and patients' overall satisfaction with their treatment experience.ConclusionsHospital managers and staff members should pay close attention to the preferences of patients and their families to improve patient experience.

Project description:Background Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56–8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.

Project description:BackgroundSuicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation.MethodA Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated.ResultsThe magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women.Conclusion and recommendationThis study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.

Project description:BackgroundEmergency Departments (EDs) play a crucial role in providing immediate medical care, particularly in densely populated countries like China. While previous research has predominantly focused on well-funded urban hospitals, this study offers a comprehensive evaluation of EDs in county-level public hospitals in Henan province, China, aiming to identify disparities and challenges.MethodsA descriptive cross-sectional survey was conducted in 382 public hospitals across Henan province, China, from July 1, 2023, to August 1, 2023. Data were collected using an electronic questionnaire covering hospital information, human resources, infrastructure, clinical capabilities, and operational capacities. The data collection period for this survey spanned from January 1 to December 31, 2022.ResultsWith a remarkable 94.0% response rate, our study reveals significant disparities in county-level public hospitals compared to their provincial or municipal counterparts in Henan Province, China. County-level hospitals, which constitute 266 of the total 342 surveyed facilities, exhibit notable differences, including fewer doctors (median: 11 vs. 23, p < 0.0001) and nurses (median: 18 vs. 37, p < 0.0001). Additionally, a higher proportion of junior doctors is observed in these hospitals, while senior medical staff are more prevalent in provincial or municipal hospitals (p < 0.001). County-level hospitals also face resource challenges, with fewer beds in the emergency room (median: 4 vs. 7, p = 0.0003) and limited proficiency in advanced clinical procedures such as POCT, fiberoptic bronchoscopy, CRRT, ECMO, ultrasound equipment operation, and intraosseous infusion, with significant differences noted in most of these capabilities (p < 0.05). Operational capabilities show distinctions as well, with county-level hospitals managing a lower patient volume (median: 14,516 vs. 34,703, p < 0.0001) and handling fewer pre-hospital CPR cases (median: 33 vs. 89, p < 0.0001). In-hospital CPR success rates are also lower in county-level hospitals (median ROSC: 25.0% vs. 42.8%, p = 0.0068).ConclusionWhile provincial or municipal hospitals enjoy better resources, county-level hospitals, especially crucial in less urbanized regions, face substantial challenges. Addressing these disparities is imperative, necessitating targeted investments, improved infrastructure, enhanced clinical training, and the adoption of innovations like telemedicine to enhance the quality of emergency care.

Dataset Information

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China.

Publications

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China.

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