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The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.
Wanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health 2020, 17, 4531 .
AMA StyleWanchun Xu, Zijing Pan, Shan Lu, Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health. 2020; 17 (12):4531.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. 2020. "Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China." International Journal of Environmental Research and Public Health 17, no. 12: 4531.
This study evaluates trends in workforce supply compared with those in the volume of service delivery (output) for basic clinical care (CC) and public health (PH) services from 2009 to 2017 in China. A cross-sectional survey (2018) was combined with retrospective data (2009–2017) from 785 primary care (PC) facilities in six provinces. Measures for the output of clinical care and of public health services were aggregated into a single (weighted) index for both service profiles. The output–workforce relationship was measured by its ratio. Latent class growth analysis and logistic regression analysis were applied to classify trajectories and determine associations with facility-level, geographic, and economic characteristics. From 2009 to 2017, the proportion of PC to overall healthcare workforce decreased from 24.25% to 18.57%; the proportion of PH to PC providers at PC facilities increased from 23.6% to 29.5%, while the proportion of PH output increased from 44.3% to 65.9%. Four trajectories of the output–workforce relationship were identified for CC, and five trajectories for PH services of which 85.3% of the facilities showed initially increasing and then slightly decreasing trends. Geographic characteristics impacted different trajectories. The PC workforce falls behind hospital workforce. The expansion in workload of PH services is unbalanced with that of workforce.
Shan Lu; Liang Zhang; Niek Klazinga; Dionne Kringos. Evolution of the Output–Workforce Relationship in Primary Care Facilities in China from 2009 to 2017. International Journal of Environmental Research and Public Health 2020, 17, 3043 .
AMA StyleShan Lu, Liang Zhang, Niek Klazinga, Dionne Kringos. Evolution of the Output–Workforce Relationship in Primary Care Facilities in China from 2009 to 2017. International Journal of Environmental Research and Public Health. 2020; 17 (9):3043.
Chicago/Turabian StyleShan Lu; Liang Zhang; Niek Klazinga; Dionne Kringos. 2020. "Evolution of the Output–Workforce Relationship in Primary Care Facilities in China from 2009 to 2017." International Journal of Environmental Research and Public Health 17, no. 9: 3043.
The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups’ vulnerability to job burnout.
Wanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health 2020, 17, 727 .
AMA StyleWanchun Xu, Zijing Pan, Zhong Li, Shan Lu, Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health. 2020; 17 (3):727.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. 2020. "Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis." International Journal of Environmental Research and Public Health 17, no. 3: 727.
The costliest 5% of the population (identified as the “high-cost” population) accounts for 50% of healthcare spending. Understanding the high-cost population in rural China from the family perspective is essential for health insurers, governments, and families. Using the health insurance database, we tallied 202,482 families that generated medical expenditure in 2014. The Lorentz curve and the Gini coefficient were adopted to describe the medical expenditure clustering, and a logistic regression model was used to identify the determinants of high-cost families. Household medical expenditure showed an extremely uneven distribution, with a Gini coefficient of 0.76. High-cost families spent 54.0% of the total expenditure. The values for family size, average age, and distance from and arrival time to the county hospital of high-cost families were 4.05, 43.18 years, 29.67 km, and 45.09 min, respectively, which differed from the values of the remaining families (3.68, 42.46 years, 30.47 km, and 46.29 min, respectively). More high-cost families live in towns with low-capacity township hospitals and better traffic conditions than the remaining families (28.98% vs. 12.99%, and 71.19% vs. 69.6%, respectively). The logistic regression model indicated that family size, average age, children, time to county hospital, capacity of township hospital, traffic conditions, economic status, healthcare utilizations, and the utilization level were associated with high household medical expenditure. Primary care and health insurance policy should be improved to guide the behaviors of rural residents, reduce their economic burden, and minimize healthcare spending.
Shan Lu; Yan Zhang; Yadong Niu; Liang Zhang. Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China. International Journal of Environmental Research and Public Health 2018, 15, 2673 .
AMA StyleShan Lu, Yan Zhang, Yadong Niu, Liang Zhang. Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China. International Journal of Environmental Research and Public Health. 2018; 15 (12):2673.
Chicago/Turabian StyleShan Lu; Yan Zhang; Yadong Niu; Liang Zhang. 2018. "Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China." International Journal of Environmental Research and Public Health 15, no. 12: 2673.
Introduction: Multi-institutional readmission refers to a 30-day readmission from one medical institution to another at different levels for the same disease. How patients transfer information is particularly important in rural China, because the doctors seldom communicate and the information system is not interconnected. This study focused on patients readmitted from township hospital to county hospital, and described how patients disclosed the information details.Methods: We screened the databases of the Medical System in 5 counties distributed in East, Central and Western China in 2013, and matched 439 pairs of medical record for multi-institutional-readmitted patients with respiratory or cerebrovascular diseases. And 2 independent medical specialists evaluated the records. Descriptive analysis and χ2 test was implied to analyze factors attributed to discontinuity.Results: A quarter of the patients did not mention their experience before readmission. 68.2% of the information mentioned was useful in the views of the specialists. More than half of the patients mentioned previous institutions and treatments, while 28.5% and 12.5% mentioned the diagnosis and the medication. Patients by referral talked about their conditions less than those readmitted voluntarily. The longer the readmission interval was, the less information passed.Discussion: Most patients were not well-educated and can’t remember the useful but professional information. Standardized medical records and effective information technology should be emphasized. The pattern and readmission interval had greater impact on patients.Conclusions: Patients did not perform well in establishing informational continuity.Lessons learned: Patients should raise their consciousness, and interconnected information system need to be constructed.Limitations: Field observation did not adopted, so the actual process was not clear.Suggestions: How to raise patients’ awareness and the management mechanism of referral should be further studied.
Shan Lu; Yan Zhang. How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China? International Journal of Integrated Care 2018, 18, 1 .
AMA StyleShan Lu, Yan Zhang. How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China? International Journal of Integrated Care. 2018; 18 (s1):1.
Chicago/Turabian StyleShan Lu; Yan Zhang. 2018. "How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China?" International Journal of Integrated Care 18, no. s1: 1.
Background: Multi-institutional readmission refers to a 30-day readmission from one medical institution to another at different levels of the same disease. The transfer of information between institutions plays a key role in establishing the continuity of care. And how patients perform seems to be particularly important in rural China, because the doctors from different hospitals seldom communicate and the information system is not interconnected. This study focused on patients readmitted from township hospitals to county hospitals, and described how patients disclosed the information details.Methods: This study focused on patients with respiratory and cerebrovascular diseases. Firstly, to get the patients who were multi-institutional readmitted, we screened the databases of the New Rural Cooperative Medical System (NCMS) in 5 counties distributed in East China, Central China and Western China from 2012 to 2013. Then, according to the identity information of patients of the screening, we matched 439 medical records in township hospitals and county hospitals. Lastly, 2 independent medical specialists evaluated the medical records on the transfer of information. Descriptive analysis was used to describe the information in records, and Chi-square test was implied to analyze factors attributed to informational discontinuity.Results: A quarter of the patients did not mention their experience before the readmission. In the views of the specialists, 68.2% of the information mentioned was useful. We categorized the information in 5 types, which were “Institution, Diagnosis, Treatment, Medication and Prognosis” about their previous hospitalization. If the information recorded has more than 2 types, we considered it an effective transfer of information. More than half of the patients mentioned previous institutions and treatments, however only 28.5% and 12.5% of them had told the doctors about the diagnosis and the medication. The effective transfer rate was 49.5%. Patients by referral were more unlikely to talk about their conditions than those readmitted voluntarily. The longer the time before readmission, the less the transfer of information.Discussion: Patients in rural China lacked of conscious awareness of informational continuity, because they do not trust doctors in township hospital and they are not aware of the benefit of transfer of information. Besides, most patients in rural China are not well-educated, so it is difficult for them to remember the useful but professional information. Standardized medical records and information technology should be emphasized. As for factors attributed to informational discontinuity, the pattern and time interval of readmission have greater impact on transfer of information. Service provided by township hospitals should be improved, and patients with complex care needs should be transmitted to county hospitals in time.Conclusions: Patients in rural China did not perform well in establishing informational continuity both in consciousness and behavior.Lessons learned: Patients should be well-educated to raise their consciousness of informational continuity. Interconnected information system need to be constructed in rural China.Limitations: Field observation did not adopted, so the actual process how patients communicated with doctors was not clear.Suggestions: How to raise patients’ awareness and the management mechanism of referral in rural China should be further studied.
Shan Lu; Wenxi Tang; Yan Zhang. How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China? International Journal of Integrated Care 2017, 17, 295 .
AMA StyleShan Lu, Wenxi Tang, Yan Zhang. How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China? International Journal of Integrated Care. 2017; 17 (5):295.
Chicago/Turabian StyleShan Lu; Wenxi Tang; Yan Zhang. 2017. "How Do Patients Perform in Establishing Informational Continuity of Care during Multi-Institutional Readmission in Rural China?" International Journal of Integrated Care 17, no. 5: 295.