The effect of different classification of hospitals on medical expenditure from perspective of classification of hospitals framework: evidence from China

Case Report: Modified endoscopic hook for extracting magnetic esophageal foreign bodies in a rural area

Foreign bodies (FB) in the aerodigestive tract are common, especially in children. The type of foreign body in the esophagus can vary and include magnets. A magnet that lodges in the esophagus should be extracted within 24 hours to prevent complications due to associated chemical reactions. In rural areas, there are several limitations to extracting FBs from the esophagus. We report a case of a magnetic FB that lodged in the esophagus of a three-year-old boy. The extraction was successfully done by esophagoscopy with the modification of a hook that was attached to the endoscope. This innovation may help physician all over the world, especially in rural areas. In the future, this innovation could be produced on an industrial scale.

Strengthening regulations, recent advances and remaining barriers in stem cell clinical translation in China: 2015-2021 in review

A new regulatory regime is being implemented under strict scrutiny for translation of stem cell medical practices since 2015 in China. The new mode of governance is strengthening to curb the marketing of unproven stem cell therapeutic products. This article begins with a brief historical overview of stem cell research and development and then focuses on the policies and country-level guidelines in the past years for stem cell translational research. This study reveals several key observations on the major progress made and the challenges associated with clinical translation of stem cells in China. Given that stem cells or stem cell-based therapeutic products are already considered as biological 'drugs', this study would be conducive to a better understanding of China's approach to stem cell translational research, marketisation and industrialization in progress.

Dynamic Demand Evaluation of COVID-19 Medical Facilities in Wuhan Based on Public Sentiment

Medical facilities are an important part of urban public facilities and a vital pillar for the survival of citizens at critical times. During the rapid spread of coronavirus disease (COVID-19), Wuhan was forced into lockdown with a severe shortage of medical resources and high public tension. Adequate allocation of medical facilities is significant to stabilize citizens’ emotions and ensure their living standards. This paper combines text sentiment analysis techniques with geographic information system (GIS) technology and uses a coordination degree model to evaluate the dynamic demand for medical facilities in Wuhan based on social media data and medical facility data. This study divided the epidemic into three phases: latent, outbreak and stable, from which the following findings arise: Public sentiment changed from negative to positive. Over half of the subdistricts in three phases were in a dysfunctional state, with a circular distribution of coordination levels decreasing from the city center to the outer. Thus, when facing major public health emergencies, Wuhan revealed problems of uneven distribution of medical facilities and unreasonable distribution of grades. This study aims to provide a basis and suggestions for the city to respond to major public health emergencies and optimize the allocation of urban medical facilities.

Bad to All? A Novel Way to Analyze the Effects of Fee-for-Service on Multiple Grades Hospitals Operation Outcomes

It is a consensus that Fee-for-Service (FFS) is a traditional medical insurance payment scheme with significant disadvantages, namely the waste of health care resources. However, the majority of the prior works that draw such conclusions from the perspective of social welfare while analyzing the impacts of FFS on operation outcomes of hospitals still lack attention from the existing literature, considering the fact that the majority of public hospitals are self-founding. Under this motivation, we collected operation data of 301 public hospitals with different grades (grade II and III) in central China. Here, we present a novel statistical evaluation framework on the impact of FFS on hospital operation outcomes from four dimensions (financial income, efficiency, medical service capacity, and sustainability) using fixed-effects multivariate regression. With verification by the robustness test, our results indicate that: (i) The classification of the hospital (COH) significantly affected the impacts of FFS on hospitals’ operations. (ii) For grade III hospitals, FFS leads to higher financial income, medical service capacity (MSC) and longer length-of-stay (LOS). (iii) However, as for grade II hospitals, hospitals with FFS adoptions achieve lower financial income, lower MSC and shorter LOS, which violates the common sense from previous works. (iv) FFS has a significant negative impact on public hospital’s sustainable development; however, there is lack of evidence showing that sustainability would be affected by the interaction effects between FFS and COH. We believe these new findings from the perspective of hospital operation provide insights and could serve as a reference for the healthcare payment hierarchical reform by COH in low and middle-income countries (LMICs), which are going through the primary stage of the healthcare reform.

Real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China: Evidence from the ACURE study

Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China. Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients' baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0. Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p < 0.001). Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.