Risk Management and Healthcare Policy最新文献

Objective: To examine the effectiveness of Quality Control Circles (QCC)in remote Electrocardiography (ECG) network management, with a particular focus on evaluating their impact on improving operational standardization.

Methods: Electrocardiogram data from Qingdao Central Hospital was selected as the research subject. Among them, 402 cases collected from January to April 2024 were before the implementation of QCC activities, and 356 cases collected from January to April 2025 were after the implementation of QCC activities. The irregularity rates of the electrocardiogram data between the two groups were compared. By establishing QCC teams, issues related to non-standardized operations at the 12-lead ECG acquisition endpoints were analyzed, and targeted improvement measures were developed.

Results: Following QCC implementation, the non-compliant operation rate at 12-lead ECG collection endpoints within the network system significantly decreased, from 17.66% to 6.17% (P<0.05), After QCC activities, members' team spirit, QC techniques, mental development, communication and coordination, activity confidence, responsibility and honorall show positive improvement.

Conclusion: QCC activities can effectively standardize ECG network operational procedures, enhancing the level of operational standardization and reducing the risk of misdiagnosis and missed diagnoses caused by non-standardized operations, thereby demonstrating clinical application value.

Introduction: Terrorist and other deliberate attacks on outpatient healthcare facilities pose a serious threat to the health and safety of the population. Strengthening the resilience of outpatient healthcare facilities to violent incidents requires a comprehensive approach that includes physical security, technological measures, staff preparedness, and effective emergency management. According to World Health Organization estimates, between 8% and 38% of healthcare workers experience physical violence during their professional career, highlighting the substantial magnitude and seriousness of this problem across healthcare systems.

Objective: The study focuses on establishing a hierarchy of key dimensions of crisis preparedness. A second objective is to propose a methodological procedure that healthcare facilities can use to determine their own hierarchy of preparedness aspects and that is sufficiently flexible to be applied across different types of facilities and healthcare systems.

Methods: The research was conducted as a mixed-methods study combining qualitative and quantitative approaches. The quantitative part used the Analytic Hierarchy Process with 30 experts from 30 different outpatient healthcare facilities. Expert inputs were obtained through pairwise comparisons provided by these thirty crisis preparedness specialists and healthcare professionals.

Results: The research revealed key shortcomings in the crisis preparedness of the analysed outpatient healthcare facilities. Six main preparedness dimensions were identified, three of which were rated as having the highest priority in the expert assessment. Based on these, the authors proposed a tool for assessing the current level of crisis preparedness, which can be applied within the internal audit of similar types of facilities.

Conclusion: The proposed tool contributes to the protection of soft targets in the healthcare sector and supports systematic planning of security measures. The study also provides a methodological framework usable by junior professionals and healthcare policy makers.

Background: This study aimed to investigate the efficacy of failure mode and effects analysis (FMEA) in optimizing the sterilization process for low-temperature hydrogen peroxide plasma sterilizers.

Methods: Purposive sampling was used to select low-temperature hydrogen peroxide plasma sterilizers from a hospital in China as the study objects. The operational data for 1551 sterilization cycles in the low-temperature hydrogen peroxide plasma sterilizers, from May 2024 to November 2024, were classified into the control group. The operational data for 1492 sterilization cycles in the low-temperature hydrogen peroxide plasma sterilizers, from January 2025 to June 2025 following the implementation of the FMEA-based risk management scheme, were classified into the experimental group. The incidence of sterilization cycle interruptions, the risk priority number scores for high-risk failure modes, and the incidence of high-risk failure modes in both groups were investigated.

Results: After the optimization of the operating procedures, the incidence of sterilization cycle interruptions decreased from 5.48% (85/1551) to 0.87% (13/1492); the risk priority number scores and the incidence of high-risk failure modes were also decreased (P < 0.05).

Conclusion: The FMEA-based risk management scheme could optimize the sterilization process for low-temperature hydrogen peroxide plasma sterilizers and ensure the quality of medical device sterilization.

Background: Air pollution remains a major global public health challenge, and reducing its harmful health effects is urgent, particularly for children. The objective of this study was to evaluate the preliminary effectiveness of knowledge-oriented education on the knowledge, attitudes, and practices (KAP) of air pollution health protection (APHP) in primary school students.

Methods: We conducted a single-arm pre-post intervention study by enrolling 635 primary school students. A two-month knowledge-oriented education intervention was performed through health lectures, educational videos, and the distribution of educational materials. A structured questionnaire was used to assess the KAP of air pollution before and after the intervention.

Results: After the intervention, the capability of air pollution protection was significantly improved as suggested by the significantly increased total score of KAP from 83.90±8.75 to 92.28±4.75, as well as its components including knowledge (20.45±3.13 vs 23.20±2.16), attitudes (31.60±4.03 vs 34.54±2.09), and practices (31.84±4.89 vs 34.52±2.67) (all P<0.05). These increments seemed to be more apparent in students who did not live with their parents and those whose mothers had a higher education level.

Conclusion: Our pilot study found that KAP of APHP was significantly improved by knowledge-oriented education in primary school students and provided preliminary evidence for its potential effectiveness in the improvement of APHP. A well-designed randomized trial is warranted to demonstrate this effectiveness.

Purpose: Despite high coverage of China's Family Doctor Contract Services (FDCS), substantive utilization among hypertensive populations remains suboptimal. By decomposing service packages into granular clinical components, this study addresses the limitations of prior research focused on generic primary care attributes. We aim to quantify patient preferences and identify heterogeneity to align service delivery with specialized management needs, thereby facilitating the transition from nominal enrollment to substantive engagement.

Methods: A Discrete Choice Experiment (DCE) was conducted to community hypertension patients in Nanjing, China. Five key attributes were identified through literature review, qualitative interviews, and expert consultation. A Mixed Logit Model (MLM) and Latent Class Model (LCM) were employed to estimate attribute importance, willingness to pay (WTP), and preference heterogeneity.

Results: Analysis of 638 responses, with 596 participants passing the internal consistency check. The Mixed Logit Model demonstrated that all five attributes exerted a statistically significant influence on patient choices. In terms of relative importance, medication type was the primary driver, followed by the scope of services, payment method, appointment scheduling, and the annual contract fee. WTP estimates indicated positive valuations for original-brand medications, integrated clinical service bundles, and multi-source payment structures. Furthermore, the Latent Class Model identified two distinct subgroups reflecting preference heterogeneity within the sample.

Conclusion: Therapeutic certainty significantly outweighs economic considerations for community hypertension patients, with the pronounced preference for original-brand medications serving as a critical proxy for clinical safety. Policy should encompass state-led support for original-drug development while simultaneously enhancing institutional trust in generic alternatives through transparent quality evidence. Transitioning toward stratified, patient-centered management is essential to address preference heterogeneity and improve the substantive effectiveness of the family doctor system in China.

Introduction: Reflective practice has emerged as a critical competency for psychiatric nurses, enabling them to critically evaluate and adapt their care approaches. Growing evidence suggests that reflective practice may serve as a key driver of high-quality caring behaviors, which are essential for establishing therapeutic relationships and improving outcomes in mental health settings. This study aimed to classify latent profiles of reflective practice among psychiatric nurses and examine their effects on caring behaviors.

Methods: This cross-sectional study was conducted to recruit psychiatric nurses from ten mental health treatment centers across ten hospitals in Sichuan Province, China, between January and March 2024. Psychiatric nurses completed an online investigation encompassing the Reflective Practice Questionnaire and the Caring Behaviors Inventory (CBI). Latent profile analysis (LPA) and hierarchical regression analysis were employed to achieve the study objectives.

Results: A total of 346 psychiatry nurses were included in this study. The reflective practice of psychiatric nurses was classified into three subgroups in this study: "passive reflective participants" (n=48, 13.9%), "moderately balanced reflective practitioners" (n=175, 50.6%), and "high-achieving reflective leaders" (n=123, 35.5%). The hierarchical regression analysis revealed a significant positive association between distinct profiles of reflective practice and psychiatric nurses' caring behaviors (ΔR² = 0.420, p < 0.001).

Conclusion: The identification of three distinct reflective practice profiles ("passive reflective participants", "moderately balanced reflective practitioners", and "high-achieving reflective leaders") provides a nuanced understanding of the reflective practice among psychiatry nurses. Targeted development programs, such as peer mentoring for the "passive" group and the "moderate" group, could be designed based on individual profile membership to optimize caring behaviors in psychiatric nursing.

Background: Accurate prognostication for trauma patients in intensive care units (ICUs) remains challenging. This study investigated whether incorporating the C-reactive protein-albumin-lymphocyte (CALLY) index into traditional ICU scoring systems could enhance mortality prediction for trauma patients.

Methods: A retrospective cohort study was performed on 1242 trauma patients hospitalized to a Level I trauma center ICU from January 1, 2016, to December 31, 2023. The CALLY index was computed using the formula = [albumin (g/dL) × lymphocyte count (10⁹/L)]/CRP (mg/L) and was incorporated with APACHE II, MPM II, MPM24 II, MPM48 II, and TRISS for predicting mortality outcomes. The predictive performance was assessed utilizing the area under the receiver operating characteristic curve (AUC).

Results: Integration of the CALLY index with APACHE II resulted in a minimal AUC increase from 0.811 to 0.812. It did not alter the AUC for MPM II, MPM24 II, or MPM48 II models (0.826, 0.845, and 0.832, respectively). For TRISS, adding the CALLY index slightly decreased the AUC from 0.731 to 0.725. The calibration curves suggest that adding the CALLY index did not markedly improve agreement between predicted and actual mortality.

Discussion: Unlike its proven efficacy in chronic conditions, the CALLY index did not significantly enhance mortality prediction in trauma patients when combined with traditional scoring systems. The reason that CALLY index did not enhance predictive power may be attributed to the acute, dynamic nature of trauma physiology, which differs from the steady-state conditions observed in chronic diseases. Further research is required to develop or refine prognostic tools specifically tailored to the unique physiological responses of trauma patients in ICU settings.

Conclusion: For ICU clinicians, these results imply that the CALLY index provides minimal improvement in mortality risk assessment for trauma patients.

Background: Medical negligence can cause patient harm and may result in malpractice lawsuits. This study examines compensation patterns in Chinese medical malpractice litigation from 2010 to 2015, the period between the 2010 Tort Liability Law and the 2018 Medical Disputes Regulation.

Methods: We collected and analyzed 5052 closed first-trial medical malpractice litigation records in China. We provided descriptive characteristics of medical malpractice cases, including the medical specialty of the alleged cases, the severity of injury, the allegation of malpractice, and the geographic regions of cases. We also presented the aggregated amounts of monetary compensation. We then used a two-part model to examine the incremental compensation associated with characteristics of medical malpractice cases, and generated the adjusted predicted mean compensation. All monetary amounts were converted to 2022 Chinese Yuan (CNY).

Results: Among all litigation records, the plaintiff received compensation in 4292 cases (85.0%). Cases involving death were significantly less likely to receive compensation and were awarded lower amounts (adjusted predicted mean: 177,374 CNY). In contrast, the severe-medium injury group received the highest adjusted predicted mean compensation compared to other injury groups (384,632 CNY). Pediatrics was associated with a significantly higher likelihood of compensation and higher compensation amounts compared to other medical specialties (adjusted predicted mean: 243,370 CNY). Delayed treatment and other adverse reactions were associated with significantly higher adjusted predicted mean compensation and ranked among the top three allegation types with the highest adjusted predicted mean compensation (176,111 CNY, 178,463 CNY, respectively), along with allergic reactions (189,746 CNY).

Conclusion: This study advances methodological approaches for analyzing medical malpractice compensation in China. Our findings provide new directions for future research into how specific allegations and medical specialties relate to compensation and lay the groundwork for future research on the alignment between injury severity and legal outcomes in China's evolving medico-legal landscape.

Objective: To explore the application effectiveness of the integration of the whole-process coding technology and Supply Processing and Distribution (SPD) supply chain management model in the management of interventional consumables.

Methods: Based on the original SPD management mode of interventional consumables in a tertiary hospital, a standardized classification and coding system was constructed, and a basic database of consumables with a unique identification code was established and integrated into various information management platforms to achieve the whole - process code management. Comparison and analysis were made on the changes in key indicators such as the timely supply rate of interventional consumables, the traceability accuracy of barcodes, the matching accuracy between consumables and pricing items, the information registration accuracy, and the billing - outbound matching rate before and after the application of the system.

Results: After the implementation of the integrated management model, all measured indicators demonstrated statistically significant improvements (p<0.05). The timeliness of consumable supply increased from 81.53% to 95.69%, traceable barcode accuracy from 85.28% to 96.39%, correct match rate between consumables and pricing items from 92.08% to 99.17%, accuracy of consumable information registration from 94.17% to 99.31%, and consistency rate between consumable pricing and inventory outflow from 96.39% to 99.58%. Staff satisfaction also significantly rose from 64.33% to 93.33% (all p<0.05).

Conclusion: This integrated management model significantly improves the lean and intelligent management of interventional consumables and demonstrates strong potential for clinical application and broader adoption.

Background: Chronic diseases are a leading cause of morbidity and mortality worldwide, creating significant health risks and adding strain to healthcare systems, particularly within rapidly aging societies. Rural older adults are especially vulnerable due to limited healthcare resources, lower socioeconomic status, and weaker support networks. Guided by the Knowledge, Attitude, and Practice (KAP) framework, this study aims to investigate chronic disease management behaviors among older patients in rural China and identify factors shaping their KAP dimensions to inform risk-responsive interventions.

Methods: A cross-sectional survey was conducted with 1320 older adults with chronic conditions across three rural regions in Zhejiang Province. Descriptive analyses were used to assess demographic characteristics, health status, daily health-related behaviors and social support structures, while multinomial logistic regression models identified different predictors significantly associated with the KAP dimensions.

Results: Overall, participants demonstrated relatively low levels across KAP dimensions, showing a pattern of attitude > practice > knowledge, with notable discrepancies among the three dimensions. Although attitudes toward chronic disease management were generally positive, deficiencies in health knowledge and proactive practices persisted. Lower educational attainment and poorer healthcare policy awareness were significantly associated with lower knowledge levels. Inactive medical care-seeking and irregular exercise habits were both associated with higher levels of indifference. For practices, respondents with weak neighborhood interactions or lack of routine health monitoring were significantly less likely to engage in proactive health behaviors, while those with minor psychological distress and low family support showed markedly greater engagement in village-level care.

Conclusion: These findings highlight the need for context-sensitive policy interventions to mitigate health risks among rural aging populations. Expanding insurance coverage, strengthening health literacy, and enhancing access to community-based and family-centred support could help improve chronic disease management. Moreover, sustained health education and regular screenings should be prioritized to close gaps between knowledge and practice in chronic disease management.