Ma Xie-Min, Chen Xiao-Hong, Wang Ji-Shan, Lyman Gary H, Qu Zhi, Ma Wen, Song Jing-Chen, Zhou Chuan-Kun, Zhao Lue Ping
School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China.
National Institute of Hospital Administration, China National Health and Family Planning Commission, Beijing, People's Republic of China.
PLoS One. 2015 Dec 1;10(12):e0140568. doi: 10.1371/journal.pone.0140568. eCollection 2015.
Healthcare reforms (HR) initiated by many countries impacts on healthcare systems worldwide. Being one of fast developing countries, China launched HR in 2009. Better understanding of its impact is helpful for China and others in further pursuit of HR. Here we evaluate inpatient mortality, a proxy to healthcare quality, in 43 top tertiary hospitals in China during this critical period. This is a hospital-based observational study with 8 million discharge summary reports (DSR) from 43 Chinese hospitals from 2010-2012. Using DSRs, we extract the vita status as the outcome, in addition to age, gender, diagnostic codes, and surgical codes. Nearly all hospitals have expanded their hospitalization capacities during this period. As of year 2010, inpatient mortality (IM) across hospitals varies widely from 2‰ to 20‰. Comparing IM of year 2011 and 2012 with 2010, the overall IM has been substantially reduced (OR = 0.883 and 0.766, p-values<0.001), showing steady improvements in healthcare quality. Surgical IM correlates with the overall IM (correlation = 0.60, p-value <0.001), but is less uniform. Over these years, surgical IM has also been steadily reduced (OR = 0.890 and 0.793, p-values<0.001). Further analyses of treatments on five major diseases and six major surgeries revealed that treatments of myocardial infarction, cerebral hemorrhage and cerebral infarction have significant improvement. Observed temporal and spatial variations demonstrate that there is a substantial disparity in healthcare quality across tertiary hospitals, and that these hospitals are rapidly improving healthcare quality. Evidence-based assessment shed light on the reform impact. Lessons learnt here are relevant to further refining HR.
许多国家发起的医疗改革对全球医疗体系产生了影响。作为快速发展的国家之一，中国于2009年启动了医疗改革。更好地了解其影响有助于中国和其他国家在进一步推进医疗改革方面。在此，我们评估了中国43家顶级三级医院在这一关键时期的住院死亡率，以此作为医疗质量的一个指标。这是一项基于医院的观察性研究，使用了来自43家中国医院2010年至2012年的800万份出院总结报告（DSR）。利用DSR，我们除了提取年龄、性别、诊断代码和手术代码外，还提取了生命状态作为结果。在此期间，几乎所有医院都扩大了住院能力。截至2010年，各医院的住院死亡率差异很大，从2‰到20‰不等。将2011年和2012年的住院死亡率与2010年进行比较，总体住院死亡率大幅下降（OR = 0.883和0.766，p值<0.001），表明医疗质量稳步提高。手术住院死亡率与总体住院死亡率相关（相关性 = 0.60，p值<0.001），但不太一致。这些年来，手术住院死亡率也在稳步下降（OR = 0.890和0.793，p值<0.001）。对五种主要疾病和六种主要手术的治疗进行进一步分析发现，心肌梗死、脑出血和脑梗死的治疗有显著改善。观察到的时间和空间差异表明，三级医院的医疗质量存在很大差距，而且这些医院正在迅速提高医疗质量。基于证据的评估揭示了改革的影响。在此吸取的经验教训与进一步完善医疗改革相关。
