《主治医生发表文章与患者再入院率的关联：基于中国三甲医院回溯性数据分析的证据》

The Association of Attending Physicians' Publications and Patients' Readmission Rates: Evidence from Tertiary Hospitals in China Using a Retrospective Data Analysis.

机构信息

Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou 510275, China.

School of Data Science, City University of Hong Kong, Kowloon Tong, Hong Kong 999077, China.

出版信息

Int J Environ Res Public Health. 2022 Aug 8;19(15):9760. doi: 10.3390/ijerph19159760.

DOI:10.3390/ijerph19159760

PMID:35955113

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9368559/

Abstract

BACKGROUND

Physicians play a unique role in scientific and clinical research, which is the cornerstone of evidence-based medical practice. In China, tertiary public hospitals link promotions and bonuses with publications. However, the weight placed on research in the clinician's evaluation process and its potential impact on clinical practice have come under controversy. Despite the heated debate about physicians' role in research, there is little empirical evidence about the relationship between physicians' publications and their clinical outcomes.

METHOD

This paper examines the association of the quantity and quality of tertiary hospitals' attending physicians' publications and inpatient readmission rates in China. We analyzed a 20% random sample of inpatient data from the Urban Employee Basic Medical Health Insurance scheme in one of the largest cities in China from January 2018 through October 2019. We assessed the relationship between the quantity and impact factor of physicians' publications and 30-day inpatient readmission rates using logistic regression. There were 111,965 hospitalizations treated by 5794 physicians in our sample.

RESULTS

Having any first-author publications was not associated with the rate of readmission. Among internists, having clinical studies published in journals with an average impact factor of 3 or above was associated with lower readmission rates (OR = 0.849; 95% CI (0.740, 0.975)), but having basic science studies published in journals with an average impact factor of 3 or above was not associated with the rate of readmission. Among surgeons, having clinical studies published in journals with an average impact factor of 3 or above was likewise associated with lower readmission rates (OR = 0.708 (0.531, 0.946)), but having basic science studies published in journals with an average impact factor of 3 or above was associated with higher readmission rates (OR = 1.230 (1.051, 1.439)).

摘要

背景

医生在科学和临床研究中扮演着独特的角色，这是循证医学实践的基石。在中国，三甲公立医院将晋升和奖金与发表文章挂钩。然而，临床医生评价过程中对研究的重视程度及其对临床实践的潜在影响引发了争议。尽管人们对医生在研究中的角色进行了激烈的辩论，但关于医生的出版物与其临床结果之间的关系的实证证据很少。

方法

本文考察了中国三甲医院主治医生发表论文的数量和质量与住院患者再入院率之间的关系。我们分析了中国最大城市之一的城镇职工基本医疗保险计划 2018 年 1 月至 2019 年 10 月的 20%随机住院患者数据。我们使用逻辑回归评估了医生发表论文的数量和影响因子与 30 天内住院患者再入院率之间的关系。在我们的样本中，有 111965 例住院患者由 5794 名医生治疗。

结果

有任何第一作者发表的论文与再入院率无关。在内科医生中，在平均影响因子为 3 或以上的期刊上发表临床研究与较低的再入院率相关（OR=0.849；95%CI（0.740，0.975）），但在平均影响因子为 3 或以上的期刊上发表基础科学研究与再入院率无关。在外科医生中，在平均影响因子为 3 或以上的期刊上发表临床研究同样与较低的再入院率相关（OR=0.708（0.531，0.946）），但在平均影响因子为 3 或以上的期刊上发表基础科学研究与再入院率相关呈正相关（OR=1.230（1.051，1.439））。