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Xiao Y, Chen TT, Zhu SY, Li CY, Zong L. Factors associated with workplace violence against Chinese healthcare workers: an online cross-sectional survey. Front Public Health 2024; 12:1295975. [PMID: 38550327 PMCID: PMC10977601 DOI: 10.3389/fpubh.2024.1295975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
Objectives Workplace violence (WPV) against healthcare workers (HCWs) has reached significant levels globally, impeding the quality and accessibility of healthcare systems. However, there is limited available knowledge regarding the determinants linked with WPV among HCWs and the discrepancies observed across various levels of hospitals in China. The objective of the present research was to investigate the factors linked to WPV and job satisfaction among HCWs in China. Methods A self-developed questionnaire based on WeChat was employed to collect data. The questionnaire consisted of demographic information as well as occupational factors. To measure WPV, the Chinese version of the Workplace Violence Scale was utilized. Career satisfaction was assessed through two questions regarding career choices. The collected data was analyzed using descriptive analyses, chi-square tests, and multivariate logistic regressions. Results A total of 3,781 valid questionnaires (1,029 doctors and 2,752 nurses) were collected. Among all participants, 2,201 (58.2%) reported experiencing at least one form of WPV in the past year, with emotional abuse being the most frequent occurrence (49.7%), followed by threats (27.9%). The multivariate logistic regression analysis revealed several risk factors associated with WPV, including male gender, shift work, senior professional title, bachelor's degree education, employment in secondary-level hospitals, and working over 50 h per week (p < 0.05). Career satisfaction among HCWs who experienced high levels of WPV was low, with only 11.2% remaining confident in their profession, and a mere 2.0% supporting their children pursuing careers in healthcare. Conclusion WPV poses a significant challenge within the Chinese healthcare system. Efforts should be made to address the identified risk factors and promote a safe and satisfying working environment for HCWs.
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Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting-ting Chen
- Nursing Department, West China Hospital of Sichuan University, Chengdu, China
| | - Shao-yi Zhu
- Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
| | - Chun-ya Li
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Ling Zong
- Department of Judicial Expertise, Zhongshan Third People’s Hospital, Zhongshan, China
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Gong H, Wang X, Zhang T, Li J, Chen B. How Can China's New Health Care Reform Promote the Balance of Interest Game?-Based on Game Evolution and Simulation Analysis. Risk Manag Healthc Policy 2023; 16:1435-1454. [PMID: 37575683 PMCID: PMC10422683 DOI: 10.2147/rmhp.s422296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The new round of medical reform is a significant exploration of reform in the public service sector in China. Health insurance regulatory departments, medical institutions, and patients, as critical stakeholders in China's medical reform, play a crucial role in the success of the reform through their strategic interactions. Patients and Methods Starting from the perspective of bounded rationality, applies evolutionary game theory to establish an evolutionary game model for the collaborative governance of health insurance regulatory departments, medical institutions, and patients and analyzes the stability of each party's strategy and the sensitivity of parameters in the tripartite game system. Results The study shows that an equilibrium point will be formed when medical institutions provide reasonable treatment, patients choose to accept treatment, and health insurance regulatory departments adopt a lenient regulatory strategy, maximizing the interests of all parties involved in the game. Factors such as the benefits of unreasonable treatment by medical institutions, fines, and regulatory costs impact the decision-making of health insurance regulatory departments. To maximize social welfare, health insurance regulatory departments should reform payment methods, adjust medical service behaviors of medical institutions, and guide the rational allocation of medical resources; the government should increase subsidies for the operation of medical institutions and the intensity of penalties; regulatory departments should reduce regulatory costs and introduce third-party forces to strengthen health insurance supervision further. Conclusion The research findings of this paper will provide valuable insights into some countries' medical and health reform.
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Affiliation(s)
- Hanxiang Gong
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Xi Wang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
| | - Tao Zhang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
| | - Jinghua Li
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Baoxin Chen
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
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Ye Y, Huang L, Wang J, Chuang YC, Pan L. Patient allocation method in major epidemics under the situation of hierarchical diagnosis and treatment. BMC Med Inform Decis Mak 2022; 22:331. [PMID: 36522752 PMCID: PMC9753027 DOI: 10.1186/s12911-022-02074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Patients are classified according to the severity of their condition and graded according to the diagnosis and treatment capacity of medical institutions. This study aims to correctly assign patients to medical institutions for treatment and develop patient allocation and medical resource expansion schemes among hospitals in the medical network. METHODS Illness severity, hospital level, allocation matching benefit, distance traveled, and emergency medical resource fairness were considered. A multi-objective planning method was used to construct a patient allocation model during major epidemics. A simulation study was carried out in two scenarios to test the proposed method. RESULTS (1) The single-objective model obtains an unbalanced solution in contrast to the multi-objective model. The proposed model considers multi-objective problems and balances the degree of patient allocation matching, distance traveled, and fairness. (2) The non-hierarchical model has crowded resources, and the hierarchical model assigns patients to matched medical institutions. (3) In the "demand exceeds supply" situation, the patient allocation model identified additional resources needed by each hospital. CONCLUSION Results verify the maneuverability and effectiveness of the proposed model. It can generate schemes for specific patient allocation and medical resource amplification and can serve as a quantitative decision-making tool in the context of major epidemics.
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Affiliation(s)
- Yong Ye
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, 318000 Zhejiang China
- Business College, Taizhou University, Taizhou, 318000 Zhejiang China
| | - Lizhen Huang
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, 318000 Zhejiang China
- Business College, Taizhou University, Taizhou, 318000 Zhejiang China
| | - Jie Wang
- School of Electronics and Information Engineering, Taizhou University, Taizhou, 318000 Zhejiang China
| | - Yen-Ching Chuang
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, 318000 Zhejiang China
- Business College, Taizhou University, Taizhou, 318000 Zhejiang China
| | - Lingle Pan
- Zhejiang College of Security Technology, Wenzhou, 325000 Zhejiang China
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Xiao Y, Du N, Chen TT, Cheng HF. High time to stop workplace violence against health professionals in the context of COVID-19. Fam Pract 2022:cmac120. [PMID: 36271839 PMCID: PMC9620320 DOI: 10.1093/fampra/cmac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Na Du
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Ting-ting Chen
- Nursing School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao-fei Cheng
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
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Xiao Y, Chen TT, Zhu SY, Zong L, Du N, Li CY, Cheng HF, Zhou Q, Luo LS, Jia J. Workplace violence against Chinese health professionals 2013-2021: A study of national criminal judgment documents. Front Public Health 2022; 10:1030035. [PMID: 36339236 PMCID: PMC9627169 DOI: 10.3389/fpubh.2022.1030035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/05/2022] [Indexed: 01/29/2023] Open
Abstract
Objectives Patient-initiated hospital violence is a global problem which threatens the safety of health professionals and is indicative of doctor-patient tensions, impeding health system quality and access. The current study aimed to improve the understanding of medical workplace violence (WPV) in China, using authoritative and nationally representative judgment records, and to approach violence prevention strategies. Methods All litigation records relating to violence against health professionals between 2013 and 2021 were extracted from the China Judgment Online System. Basic case information, victim characteristics, perpetrator characteristics and the nature of the violence were collated. The relationship between different treatment outcomes and violence was also explored. Results Numbers of cases of hospital violence gradually increased from 2013 to a peak in 2016 before gradually decreasing in the following years. The most common perpetrators were patients' relatives (58.2%), followed by patients themselves (38.2%). Only 9 perpetrators had a confirmed history of mental illness and only two were intoxicated with alcohol. More than half of the cases (52.5%) occurred in rural areas and this percentage is even greater for primary health care institutions (71.4%) and secondary hospitals (73.5%). On a departmental level, the highest incidence of medical WPV was found in the emergency (18.9%), pediatrics (13.2%) and obstetrics (11.5%) departments. Violent behaviors, such as stalking, mass occupation of the ward and sharp instrument injury were significantly related to cases not involving patient death (p < 0.05). Disruptive behavior, such as hanging banners, blocking hospital passages, placing flower wreaths and burning paper money were significantly correlated with cases involving patient death (p < 0.01). The interval between a patient's death and the ensuing violence was short, happening on the same day in 54.8% of cases. Conclusions A comprehensive overview of medical WPV in China is presented and may have utility for the formulation of prevention strategies.
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Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China,Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Yu Xiao
| | - Ting-ting Chen
- Nursing School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shao-yi Zhu
- Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
| | - Ling Zong
- Department of Judicial Expertise, Zhongshan Third People's Hospital, Zhongshan, China
| | - Na Du
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Chun-ya Li
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Hao-fei Cheng
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Qi Zhou
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Li-shi Luo
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Juan Jia
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
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Hou Y, Tao W, Hou S, Li W. Levels, trends, and determinants of effectiveness on the hierarchical medical system in China: Data envelopment analysis and bootstrapping truncated regression analysis. Front Public Health 2022; 10:921303. [PMID: 36203685 PMCID: PMC9530448 DOI: 10.3389/fpubh.2022.921303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Background The hierarchical medical system (HMS) refers to the classification of treatment according to disease priorities based on severity and difficulty to promote the fairness of medical services for residents, which is regarded as the key to the success of medical reform in China. Methods In the past decade of "New Medical Reform," the efficiency of HMS, including secondary and tertiary hospitals and primary healthcare centers (PHCs), was measured horizontally and vertically by employing the combination of an output-oriented superefficiency slack-based model-data envelopment analysis (SE-SBM-DEA) model with the Malmquist total factor productivity index (MTFP). In the second stage, the overall technical efficiency (OTE) scores were regressed against a set of environmental characteristics and several managerial factors through bootstrapping truncated regression. Results On average, the OTE score in tertiary hospitals was 0.93, which was higher than that in secondary hospitals and PHCs (0.9 and 0.92, respectively). In terms of trend, the OTE of tertiary hospitals declined at first and then increased. The opposite was true of secondary hospitals, in which the APC of the OTE was 10.82 and -3.11% in early and late 2012, respectively. The PHCs generally showed a fluctuating downward trend. In the aspects of productivity, all institutions showed a downturn by an annual average rate of 2.73, 0.51, and 2.70%, respectively. There was a significant negative relationship between the ratio of outpatients to inpatients and tertiary hospitals. Additionally, the medical technical personnel per 1,000 population negatively affected PHCs. In contrast, the GDP per capita had a significantly positive effect on tertiary hospitals, and the number of beds per 1,000 population positively influenced PHCs. Conclusion The efficiency of medical institutions at various levels in HMS was unbalanced and took the form of an "inverted pyramid." Multilateral factors influence the efficiency of HMS, and to address it, multi-intervention packages focusing on sinking high-quality medical resources and improving healthcare capacity, and guiding hierarchical medical practice should be adopted.
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Affiliation(s)
- Yuanxin Hou
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Shufen Hou
- Department of Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Weimin Li
- President's Office, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Weimin Li
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Xiao Y, Du N, Chen J, Li YL, Qiu QM, Zhu SY. Workplace violence against doctors in China: A case analysis of the Civil Aviation General Hospital incident. Front Public Health 2022; 10:978322. [PMID: 36111194 PMCID: PMC9468869 DOI: 10.3389/fpubh.2022.978322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/12/2022] [Indexed: 01/25/2023] Open
Abstract
Background Violence against health professionals is a global public health problem. In 2019, a doctor was killed in Civil Aviation General Hospital (CAGH), which triggered national discussion about hospital violence. Sina Weibo, the Chinese version of Twitter, played an important role in this public discussion. The CAGH incident provides us with an opportunity to explore how social media was used in the discussion on violence against doctors. Methods Using the built-in search engine of Sina Weibo, a data set containing 542 Chinese micro-blogs was established. Three keywords: Civil Aviation General Hospital, doctor, and knife were used to search for related posts between December 24th, 2019 and January 19th, 2020. We made a content analysis of the posts to investigate: Weibo users' demographics, views about the incident of CAGH, and measures to prevent hospital violence. Results Overall, 89.3% of the posts were sent by individual Weibo users, and 10.7% by organizations. Among the individual users, doctors accounted for 27.4%, but only 1.0% came from the legal profession. In addition, 86.7% of the micro-blogs expressed sympathy for the attacked doctor, and 23.1% of the micro-blogs thought that the imperfect medical system was the main cause of the accident. Nearly half of the posts described their disappointment with the government and the society, and 58.6% of medical staff users expressed regret for engaging in medical work. Only 14.2% of micro-blogs put forward some constructive strategies to prevent hospital violence. Conclusion Weibo users played an important role in spreading and discussing the CAGH incident. However, constructive measures to protect doctors were rarely mentioned, and legal opinions were not reflected in time. Hospital violence has caused public dissatisfaction with the government and weakened the professional confidence of medical staff. Occupational health and public health stakeholders must take effective measures to solve workplace violence against doctors.
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Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China,Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Yu Xiao
| | - Na Du
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Jia Chen
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Ya-lan Li
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Qin-ming Qiu
- Department of Psychiatry, Huzhou Third People's Hospital, Huzhou, China
| | - Shao-yi Zhu
- Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
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Structural Equation Modeling Analysis of Factors Influencing Family Doctor Contracted Services Based on Survey Data from Changning District, Shanghai. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2648833. [PMID: 35783524 PMCID: PMC9246594 DOI: 10.1155/2022/2648833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/08/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022]
Abstract
Objective Family doctors fulfill the role of gatekeepers in protecting residents' health with contracted services. Providing these valuable services involves multiple causes, relationships, and indirectly observable variables. This study used structural equation modeling to construct a dynamic model of the work of family doctors to provide a basis for incentives. Methods This study used 2-year follow-up data from a survey of 294 family doctors in Changning District, Shanghai. Data were analyzed using confirmatory factor analysis and structural equation modeling. The measurement model and structural model were defined, identified, verified, integrated, and revised to identify the factors motivating family doctors to provide contracted services. A dynamic path for the family doctor contracted services model was established and eventually modified with six endogenous latent variables: cognition, environmental satisfaction, income satisfaction, support satisfaction, stability, and contracting performance, underpinned by 27 measurement variables. Result The standardized regression coefficient of the effect of cognition on environmental satisfaction was 0.37 (P < 0.05) and the degree of variation interpretation was 0.14. The effect of cognition on income satisfaction was 0.54 (P < 0.05) and the degree of variation interpretation was 0.29. The effect of cognition on stability was 0.40 (P < 0.01), the effect of environmental satisfaction on stability was 0.12 (P < 0.05), and the effect of income satisfaction on stability was 0.22 (P < 0.05), all with a degree of variation interpretation of 0.369. Finally, the effect of stability on contracting performance was 0.51 (P < 0.05) with a degree of variation interpretation of 0.343. Conclusions The degree of family doctors' understanding (cognition) of their own work largely determines their behavioral orientation and service effectiveness. These results raise the possibility of enhancing family doctors' work stability and improving the performance of contracted services by increasing the income of family doctors.
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Li J, Zhao N, Zhang H, Yang H, Yang J. Patients' Willingness of First Visit in Primary Medical Institutions and Policy Implications: A National Cross-Sectional Survey in China. Front Public Health 2022; 10:842950. [PMID: 35433566 PMCID: PMC9010779 DOI: 10.3389/fpubh.2022.842950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs. Methods We employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression. Results Of the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs. Conclusions Due to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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Jiang Q, Lou Y, Chen F, Lu Z, Cao S. Keys to promoting the graded diagnosis and treatment system based on the integrated health care system in China. Fam Pract 2022; 39:217-218. [PMID: 34423371 DOI: 10.1093/fampra/cmab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qingqing Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yiling Lou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Chen
- Quality Control Office, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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