Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China.
Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
Hum Resour Health. 2023 Aug 8;21(1):62. doi: 10.1186/s12960-023-00851-3.
This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data.
Data on nephrologists in China were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models.
Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio [IRR] 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city.
The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12-20 nephrologists pmp is suggested.
本研究旨在描述中国肾脏病学从业人员的现状，并基于真实患者流动数据评估其最佳容量。
使用网络爬虫和自然语言处理技术从两个知名在线医疗保健平台收集中国肾脏病学家的数据。从中国国家行政数据库中提取 2014 年 1 月至 2018 年 12 月慢性肾脏病（CKD）患者的住院记录。确定患者流动的城市级路径。使用多元泊松回归模型分析肾脏病学劳动力对患者流动的影响。
每百万人口（pmp）共有 9.13 名肾脏病学家，城市间存在显著差异，范围从 0.16 到 88.79。肾脏病学家与估计的 CKD 人群的比例为 84.57 pmp。在 6415599 例 CKD 患者的住院中，21.3%是跨城市住院，确定了 7441 条超过 5 次住院的城市级患者流动路径。在调整医疗保健能力、医疗保险、经济状况和旅行特征后，泊松回归模型显示来源城市（发病率比 [IRR] 0.99，每增加 1 pmp）和目的地城市（IRR 1.07，每增加 1 pmp）中肾脏病学家数量与患者流动独立相关。当来源城市的肾脏病学家数量超过 12 pmp 时，观察到 IRR 平台，而当目的地城市的肾脏病学家数量超过 20 pmp 时，IRR 迅速增加。
中国肾脏病学劳动力存在显著的地域差异。根据当地医疗保健需求，建议最佳范围为 12-20 名 pmp。
