Wenya Yu

Determinants and influencing mechanism of outpatient satisfaction: a survey on tertiary hospitals in the People’s Republic of China

Objective Most patients in the People’s Republic of China prefer tertiary hospitals when seeking medical services. The aim of this study was to assess outpatient satisfaction with tertiary hospitals in the People’s Republic of China, test overall and subscale satisfaction, and explore whether sociodemographic characteristics lead to different degrees of satisfaction and whether subscale outpatient satisfaction contributes to overall satisfaction. Methods A closed questionnaire was given out to investigate outpatients’ sociodemographic characteristics, overall satisfaction, and various subtypes of satisfaction, and a 5-point Likert scale was employed to measure the degree of outpatient satisfaction. Descriptive analysis, Kruskal–Wallis test, Spearman’s rank correlation coefficient, and logistic regression analysis were employed for statistical analysis. Results Response rate was 92.48% (971/1,050). Outpatients’ sociodemographic characteristics (including sex, age, occupation, monthly income, residence, and marital status) were related to various subtypes of satisfaction to varying degrees. Outpatients who were male, older, married, with low or middle incomes, living in Shanghai or other areas of the People’s Republic of China, medical staff, or students were more satisfied with various subtypes of satisfaction than those without these characteristics. In further analyses, satisfaction with their medical needs being met by doctors had the strongest relation to overall satisfaction, followed by satisfaction with doctors’ service attitudes, medical costs, waiting time, prescription, and diagnosis and treatment time. Satisfaction with environment had the weakest contribution to overall satisfaction. Conclusion This study gave some suggestions for tertiary hospitals in advanced areas of the People’s Republic of China. Outpatient sociodemographic characteristics should be paid more attention by medical staff to improve the degree of satisfaction. Tertiary hospitals in the People’s Republic of China should provide more support on the management of doctors, medical costs, and time.

Health Status and Risk Factors among Adolescent Survivors One Month after the 2014 Ludian Earthquake.

Background: An earthquake struck Ludian in Yunnan Province (China) on 3 August 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the health status and associated determinants among adolescent survivors after the Ludian earthquake. Methods: A cross-sectional survey of 845 was conducted at the Ludian No. 1 Middle School. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. Results: The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.23 (SD = 7.10) and 36.34 (SD = 7.09), respectively. Lower PCS scores in the aftermath of an earthquake were associated with being trapped or in danger, being female, being an ethnic minority, injury to self and house damage, while lower MSC scores were associated with fear during the earthquake, Han ethnicity, death in the family, not being involved in the rescue and low household income. Conclusions: In our study, significant associations between demographic, socio-economic, and trauma-related experiences variables and overall physical and mental health of adolescent survivors were presented. The results of this study help expand our knowledge of health status among adolescent survivors after the Ludian earthquake.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model

Objectives Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. Methods This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Results Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. Conclusion The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study

Objectives This study aimed to assess patients’ healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients’ healthcare-seeking preference. Design A retrospective study. Setting The study was conducted in 14 tertiary hospitals in Shanghai, China. Participants Questionnaires were distributed to 1519 patients, and 1114 were completed and returned. All patients participated in the study voluntarily, provided written informed consent, and possessed the ability to complete the questionnaire. Main outcome measures We measured and compared preferences and choice of healthcare providers in patients if they had experienced mild, chronic, or serious illness. Results More than 50% of participants, including those who were >60 years of age, had consulted a doctor more than three times during the preceding year, were single, and were most likely to decide not to seek medical treatment. Community health facilities were the most frequently selected healthcare provider in mild illness. In addition, patients who had no personal preference, did not express a preference for a good environment or first-class medical technology, were concerned about close proximity and short waiting times, and pursued low medical costs were most likely to choose a community health facility. General hospitals were the most frequently selected healthcare provider in chronic and serious illness. In addition, patients who earned higher monthly incomes, did not pursue low medical costs, were not concerned about short waiting times or close proximity, and expressed a preference for first-class medical technology, were most likely to choose general hospitals. Conclusion Patients’ healthcare-seeking preference was influenced mainly by healthcare providers’ characteristics, illness severity, and sociodemographic characteristics. These findings indicate that patients’ current healthcare-seeking preference was not ideal and requires optimisation.

Factors influencing two-way referral between hospitals and the community in China: A system dynamics simulation model:

Background: Two-way referrals between hospitals and community healthcare systems (CHSs) are important for optimizing the distribution of medical resources and enabling resource sharing, but referrals are always from CHSs to hospitals. A referral from the hospital to the community is rare in China; this has a highly negative impact on the long-term development of the Chinese health services. The aim of this study was to address influence factors in hospital–community referrals. Methods: We constructed a system dynamics model to address the problem of the two-way referral between hospitals and CHSs and identified potential countermeasures and possible solutions. The Vensim DSS program was used to construct a system dynamics model to represent the problem through model description, causal loop diagrams, and stock and flow diagrams. Results: The model was used to perform intervention experiments, in which the influence on all the sectors of referrals could be observed by changing the system parameters. The experimental results showed a greater difference in medical costs between hospitals and CHSs, more investments to CHSs, higher levels of medical insurance of CHSs, and more referrals from hospitals to CHSs. Conclusions: The system can widen the price gap between hospitals and CHSs, increase information flow, improve medical insurance level of CHSs, and elevate the current level of CHSs through enabling two-way referral between hospitals and CHSs.

Comparison of influencing factors on outcomes of single and multiple road traffic injuries: A regional study in Shanghai, China (2011-2014)

Introduction To identify key intervention factors and reduce road traffic injury (RTI)-associated mortality, this study compared outcomes and influencing factors of single and multiple road traffic injuries (RTIs) in Shanghai. Methods Based on the design of National Trauma Data Bank, this study collected demographic, injury, and outcome data from RTI patients treated at the four largest trauma centers in Shanghai from January 2011 to January 2015. Data were analyzed with descriptive statistics, univariate analysis, and hierarchical logistic regression analysis. Results Among 2397 participants, 59.4% had a single injury, and 40.6% had multiple injuries. Most patients’ outcome was cure or improvement. For single-RTI patients, length of stay, body region, central nervous system injury, acute renal failure, multiple organ dysfunction syndrome, bacterial infection, and coma were significantly related to outcome. For multiple-RTI patients, age, admission pathway, prehospital time, length of stay, number of body regions, body region, injury condition, injury severity score, and coma were significantly related to outcome. Conclusions Emergency rescue in road traffic accidents should focus on high-risk groups (the elderly), high-incidence body regions (head, thorax, pelvis) and number of injuries, injury condition (central nervous system injury, coma, complications, admission pathway), injury severity (critically injured patients), and time factors (particularly prehospital time).

Study on the Health Status and Health Service Utilization of the Elderly of a Remote and Poor Village in a Mountainous Area in Jinzhai, Anhui

Background: Despite the rapid development of China’s economy, a number of poor areas in China continue to exist. The health status of the elderly in the poor areas is a matter of concern. This study aims to explore the status of the elderly in terms of their health status, health service needs, and utilization among rural residents of a remote and poor village in a mountainous area in Jinzhai, Anhui. Furthermore, this study aims to explore the differences between the nation rural area average level and the remote and poor village in the mountainous area in terms of health status and health service utilization. Methods: Cluster sampling was used to obtain the sample. A total of 110 elderly people were selected from the village, and face-to-face interviews were conducted with questionnaires by trained investigators to collect data. Results: All items except vision, language disability, and self-care disability were found to be higher than the national average level. In terms of mental health, Zishu Village has a ratio of 44.1% for the symptoms of anxiety and depression, which is higher than the average for the national rural areas. The two-week prevalence rate, prevalence of chronic diseases, and non-hospitalization rate of those who need hospitalization (%) in Zishu Village was 62.7%, 88.2%, and 47.6% respectively, which was higher than the rural values of the National Survey (2008). Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. The two-week visiting rate was 24.1%, which was lower than 2008. The hospitalization rate in Zishu Village was 10.8%, which is similar to the level of 2008. Conclusions: The health level and the utilization of health services of the people in Zishu Village, Jinzhai, are generally lower than the national average. Financial difficulties continue to remain the major factor affecting the utilization of hospitalization services of this remote and poor village in Jinzhai, Anhui.

Modeling Hospital Transition from Peacetime to Wartime

The research followed the ideology of “evidence-based research” to investigate mechanism of potentiality management, capability development, as well as implementation of civilian hospital mobilization. Referring on complex adaptive system (CAS) modeling theory, the author set up a CHM system dynamics (SD) model with research methods, especially SD modeling technique. With the SD model of CHM system, the behavioral rules were stimulated and analogue simulation of system structure and complicated behavior was realized, thus providing a test platform for relevant policymaking. Then the intervening tests were carried out on the platform to find the intervening target for improving system performance. Policy recommendations proposed to increase the capacity of CHM system provide a theoretical basis for the building of mobilization capacity.

Modeling the Medical Rescue Forces Allocation in Earthquakes

Medical rescue forces are the basis of earthquake rescue efforts. The allocation of medical rescue forces played vital role in the rescue efforts. This chapter mainly introduced the background, objective, significance, and technical route of medical rescue force allocation in earthquakes. The author described the process of the construction of medical rescue forces allocation model in earthquake. Based on the model construction, the systemic simulation and intervention were carried out so as to provide some suggestions on the allocation of medical rescue efforts.