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首页> 美国卫生研究院文献>PLoS Clinical Trials >Evolving Healthcare Quality in Top Tertiary General Hospitals in China during the China Healthcare Reform (2010–2012) from the Perspective of Inpatient Mortality
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Evolving Healthcare Quality in Top Tertiary General Hospitals in China during the China Healthcare Reform (2010–2012) from the Perspective of Inpatient Mortality

机译：从住院死亡率出发，中国医疗改革（2010-2012年）期间顶级三级综合医院医疗质量的演变

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Healthcare reforms (HR) initiated by many countries impacts on healthcare systems worldwide. Being one of fast developing countries, China launched HR in 2009. Better understanding of its impact is helpful for China and others in further pursuit of HR. Here we evaluate inpatient mortality, a proxy to healthcare quality, in 43 top tertiary hospitals in China during this critical period. This is a hospital-based observational study with 8 million discharge summary reports (DSR) from 43 Chinese hospitals from 2010–2012. Using DSRs, we extract the vita status as the outcome, in addition to age, gender, diagnostic codes, and surgical codes. Nearly all hospitals have expanded their hospitalization capacities during this period. As of year 2010, inpatient mortality (IM) across hospitals varies widely from 2‰ to 20‰. Comparing IM of year 2011 and 2012 with 2010, the overall IM has been substantially reduced (OR = 0.883 and 0.766, p-values<0.001), showing steady improvements in healthcare quality. Surgical IM correlates with the overall IM (correlation = 0.60, p-value <0.001), but is less uniform. Over these years, surgical IM has also been steadily reduced (OR = 0.890 and 0.793, p-values<0.001). Further analyses of treatments on five major diseases and six major surgeries revealed that treatments of myocardial infarction, cerebral hemorrhage and cerebral infarction have significant improvement. Observed temporal and spatial variations demonstrate that there is a substantial disparity in healthcare quality across tertiary hospitals, and that these hospitals are rapidly improving healthcare quality. Evidence-based assessment shed light on the reform impact. Lessons learnt here are relevant to further refining HR.
机译：许多国家/地区发起的医疗保健改革（HR）对全球医疗保健系统产生影响。作为快速发展的国家之一，中国于2009年启动了人力资源管理。更好地了解其影响有助于中国和其他国家进一步追求人力资源。在这里，我们评估了这个关键时期中国43家顶级三级医院的住院病人死亡率，这是医疗质量的代表。这是一项基于医院的观察性研究，2010年至2012年间，中国43家医院的出院总结报告（DSR）达到800万。使用DSR，除了年龄，性别，诊断代码和手术代码之外，我们还提取维生素状态作为结果。在此期间，几乎所有医院都扩大了住院能力。截至2010年，各医院的住院死亡率（IM）在2‰至20‰之间变化很大。将2011年和2012年与2010年的IM进行比较，整体IM显着降低（OR = 0.883和0.766，p值<0.001），显示出医疗质量的稳步提高。手术IM与整体IM相关（相关= 0.60，p值<0.001），但不太均匀。这些年来，外科手术的IM也在稳步降低（OR = 0.890和0.793，p值<0.001）。对五种主要疾病和六种主要手术的治疗方法的进一步分析表明，心肌梗塞，脑出血和脑梗塞的治疗方法有显着改善。观察到的时空变化表明，三级医院的医疗质量存在很大差异，并且这些医院正在迅速改善医疗质量。循证评估揭示了改革的影响。此处吸取的教训与进一步完善人力资源有关。

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