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Wang W, van Wijngaarden J, Wang H, Buljac-Samardzic M, Yuan S, van de Klundert J. Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review. FRONTIERS IN HEALTH SERVICES 2021; 1:766677. [PMID: 36926484 PMCID: PMC10012679 DOI: 10.3389/frhs.2021.766677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process. Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence. Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.
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Affiliation(s)
- Wenxing Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hujie Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Shasha Yuan
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Mohammad Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia
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Li H, Cheng B, Chen Y. What causes high costs for rural tuberculosis inpatients? Evidence from five counties in China. BMC Infect Dis 2020; 20:501. [PMID: 32652944 PMCID: PMC7353759 DOI: 10.1186/s12879-020-05235-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) still causes high economic burden on patients in China, especially for rural patients. Our study aims to explore the risk factors associated with the high costs for TB inpatients in rural China from the aspects of inpatients' socio-demographic and institutional attributes. METHODS Generalized linear models were utilized to investigate the factors associated with TB inpatients' total costs and out-of-pocket (OOP) expenditures. Quantile regression (QR) models were applied to explore the effect of each factor across the different costs range and identify the risk factors of high costs. RESULTS TB inpatients with long length of stay and who receive hospitalization services cross provincially, in tertiary and specialized hospitals were likely to face high total costs and OOP expenditures. QR models showed that high total costs occurred in Dingyuan and Funan Counties, but they were not accompanied by high OOP expenditures. CONCLUSIONS Early diagnosis, standard treatment and control of drug-resistant TB are still awaiting for more efforts from the government. TB inpatients should obtain medical services from appropriate hospitals. The diagnosis and treatment process of TB should be standardized across all designated medical institutions. Furthermore, the reimbursement policy for migrant workers who suffered from TB should be ameliorated.
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Affiliation(s)
- Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Institute of Model Animals of Wuhan University, Wuhan, 430072 China
- Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030 Hubei China
| | - Bin Cheng
- China National Health Development Research Center, Beijing, 100044 China
| | - Yingchun Chen
- Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030 Hubei China
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
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Hsieh MJ, Huang YW, Tsai YH, Feng JY, Su WJ. Improved appropriateness of anti-tuberculosis prescription by the expert prescription review program in Taiwan. J Formos Med Assoc 2020; 119:1658-1665. [PMID: 31932200 DOI: 10.1016/j.jfma.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A nationwide program initiated by Taiwan CDC was conducted by the Taiwan Society of Tuberculosis and Lung Disease to improve the appropriateness of anti-TB prescriptions in Taiwan. METHODS All anti-TB prescriptions from 12 hospitals across Taiwan were reviewed by experienced pulmonologists, according to the 2011 Taiwan TB treatment guidelines, between May and October 2013. The investigation period was divided into three stages: May to June, July to August, and September to October. The concordance rates between anti-TB prescriptions and the guidelines were compared among the three stages and between medical centers and regional hospitals. RESULTS A total of 2574 new anti-TB prescriptions were reviewed. The appropriateness of anti-TB prescriptions was 82.0%. The most dominant error was inappropriate dosage of anti-TB medications. The appropriateness improved significantly with prescription review, and the concordance rates were 78.7%, 80.6%, and 87.6% in stages 1, 2, and 3, respectively (P < 0.001). The inappropriateness of medication dosage also improved significantly, with the rates of inappropriate dosage dropping from 10.2% in stage 1-5.4% in stage 3 (Odds ratio 0.491, P < 0.001). The appropriateness rates showed no significant difference between regional hospitals and medical centers (82.5% vs. 81.3%, Odds ratio 0.915, P = 0.393), but the improvement of prescription appropriateness was significant in regional hospitals but not in medical centers. CONCLUSION Prescription review by TB experts is an effective approach to improve the appropriateness of anti-TB prescriptions.
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Affiliation(s)
- Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Yi-Wen Huang
- Respiratory and Critical Care Center, Changhua Hospital, Ministry of Health & Welfare, Changhua, Taiwan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan; Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan
| | - Jia-Yih Feng
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Mao W, Jiang W, Hamilton C, Zhang H, Huang F, Lucas H, Huan S, Tang S. Over- and under-treatment of TB patients in Eastern China: an analysis based on health insurance claims data. Trop Med Int Health 2019; 24:1078-1087. [PMID: 31299130 PMCID: PMC6851836 DOI: 10.1111/tmi.13287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines. Methods We collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of ‘pulmonary TB’ in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out‐of‐pocket (OOP) payments and effective reimbursement rates were analysed. Results A total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients. Conclusions We found an alarming extent of TB over‐ and under‐treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.
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Affiliation(s)
- Wenhui Mao
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Weixi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | | | - Hui Zhang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Fei Huang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Henry Lucas
- Institute of Development Studies, Sussex University, Brighton, UK
| | | | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
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Bai J, Bundorf K, Bai F, Tang H, Xue D. Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China. BMJ Open 2019; 9:e027540. [PMID: 31142531 PMCID: PMC6549614 DOI: 10.1136/bmjopen-2018-027540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Many strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals' use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs. DESIGN A retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital's use of financial incentives to influence CP compliance. SETTING Eighteen public hospitals in three provinces in China. PARTICIPANTS Stratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014. PRIMARY OUTCOME MEASURES The proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy). RESULTS The average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance. CONCLUSION CPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.
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Affiliation(s)
- Jie Bai
- Hospital Management, School of Public Health, Fudan University, Shanghai, China
- CHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, China
| | - Kate Bundorf
- Health Research and Policy, School of Medicine, Stanford University, Stanford, California, USA
| | - Fei Bai
- Technological Guidance, National Center for Medical Service Administration, Beijing, China
| | - Huiqin Tang
- Medical Administration, Health Commission of Hubei Province, Wuhan, China
| | - Di Xue
- Hospital Management, School of Public Health, Fudan University, Shanghai, China
- CHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, China
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Bai J, Bai F, Zhu H, Xue D. The perceived and objectively measured effects of clinical pathways' implementation on medical care in China. PLoS One 2018; 13:e0196776. [PMID: 29734350 PMCID: PMC5937784 DOI: 10.1371/journal.pone.0196776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 04/19/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Substantial resources have been expended on clinical pathways (CPs), but the reported effects of CPs on medical care vary considerably. This study sought to determine the effects of CPs on medical care in Chinese hospitals, including the perceived effects of CPs on medical care and the objectively measured patient outcomes. Methods Study data were obtained from 54 public hospitals in three provinces of China in 2015. Hospital questionnaires, employee surveys, and chart reviews were used to collect data related to hospital characteristics, the implementation of CPs and compliance status, perceived effects of CPs, and objectively measured patient outcomes. Logistic regression models and linear regression models were adopted in this study. Results The effects of CPs were not highly perceived by the hospitals or by the managers and physicians in China. The relatively low involvement in the implementation of and adherence to CPs resulted in CPs having no significant effects on hospital medical care as a whole. However, a chart review of 5 conditions in Chinese hospitals demonstrated that compliance with national CPs reduced the length of stay (LOS) and inpatient medical costs. Conclusions CPs should be implemented widely and followed closely to improve hospital medical care as a whole, and further studies should be conducted to identify the key elements of the effects of CPs on patient clinical outcomes.
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Affiliation(s)
- Jie Bai
- Department of Hospital Management, School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission (Fudan University), Fudan University, Shanghai, P.R. China
| | - Fei Bai
- Center for Medical Service Administration, National Health Commission of China, Beijing, P.R. China
| | - Hongbo Zhu
- Medical Administration and Management, Health and Family Planning Commission of Hubei Province, Wuhan, P.R. China
| | - Di Xue
- Department of Hospital Management, School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission (Fudan University), Fudan University, Shanghai, P.R. China
- * E-mail:
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Adejumo OA, Daniel OJ, Gidado M, Otesanya AF, Adejumo EN, O. Jaiyesimi E, Esther Idowu O, O. Odusanya O. Are Tuberculosis Patients Managed According to the National Guidelines in Lagos State Nigeria? ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijcm.2016.71003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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