Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.
National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China.
Int J Environ Res Public Health. 2022 Jul 27;19(15):9144. doi: 10.3390/ijerph19159144.
There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, which were sampled from 6 county hospitals in 3 counties of eastern China. The average proportion of recommended care delivered included stroke, pneumonia, and heart failure patients at 55.36%, 41.64%, and 49.56%, respectively. Great variation of QoC was detected not only across selected counties but between comprehensive county hospitals and traditional Chinese medicine county hospitals. We deny the widely-accepted assumptions that poor QoC should be blamed on defectively-equipped facilities or medicine and overwhelmed care providers. Instead, we speculate the low qualifications of medical workers, failed clinical knowledge translation, incorrect diagnosis, and a lack of electronic systems could be the reasons behind poor QoC. It is high time for China to put QoC as the national health priority.
在中国县级医院中，很少有关于医疗质量（QoC）的研究。我们使用临床路径的 7、6 和 6 个标准操作作为过程指标，分别评估了脑卒中、肺炎和心力衰竭的护理质量。我们还进行了卡方检验，以检测选定县或医院之间的质量差异。我们从中国东部 3 个县的 6 家县级医院的 421 例脑卒中病例、329 例肺炎病例和 341 例心力衰竭病例的病历中提取了相关信息。推荐护理的平均比例包括脑卒中、肺炎和心力衰竭患者，分别为 55.36%、41.64%和 49.56%。不仅在选定的县之间，而且在综合县级医院和传统中医县级医院之间，都发现了 QoC 的巨大差异。我们否认质量差应该归咎于设备或药物配备不完善以及医护人员不堪重负的普遍观点。相反，我们推测医疗工作者的资质低、临床知识转化失败、诊断错误以及缺乏电子系统可能是质量差的原因。现在是中国将 QoC 作为国家卫生重点的时候了。
