中国基层医疗质量与医疗服务提供者的差异:基于标准化病人的研究

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-21 DOI:10.1016/j.lanwpc.2024.101161
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引用次数: 0

摘要

背景初级医疗保健是高效医疗系统的基础。要改善初级医疗系统,就必须全面了解系统内不同医疗服务提供者目前的医疗质量。作为世界上最大的发展中国家,中国在过去十年中对初级医疗进行了大量投资。本研究评估了中国不同医疗机构的基层医疗质量,为加强中国的基层医疗体系提供了启示。方法我们合并了四个标准化病人(SP)研究项目的数据,比较了中国五个主要基层医疗机构的医疗质量:农村诊所、县级医院、农民工诊所、城市社区卫生服务中心(CHC)和网络平台。我们从流程质量(如检查表的完成情况)、诊断质量(如诊断的准确性)和病例管理(如用药的正确性)三个方面对医疗质量进行了评估,并采用多元回归分析探讨了不同医疗机构的质量差异及其与医生特征之间的关联。从流程质量、诊断准确性和处方正确性来看,社区卫生服务中心是相对可靠的初级医疗服务提供者。在线平台在很多方面都超过了乡镇卫生院、县级医院和流动人口诊所,显示了其在资源不足的农村地区提高优质医疗资源可及性的潜力。我们观察到医生的资质与初级医疗质量之间存在正相关,这强调了更多高资质医生的存在的必要性。 解释在中国,不同医疗服务提供者的初级医疗质量差异很大,这反映了医疗服务的不平等。虽然在线平台显示出改善资源匮乏地区医疗服务的潜力,但其高转诊率表明它们不能完全替代传统医疗服务。研究结果强调,需要更多合格的从业人员和严格的监管,以提高医疗质量,减少不必要的治疗。我们已在修订稿中对此予以确认。
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Primary care quality and provider disparities in China: a standardized-patient-based study

Background

Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system.

Methods

We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics.

Findings

We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners.

Interpretation

Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments.

Funding

No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.

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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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