Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China

Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.

Data mining-based model and risk prediction of colorectal cancer by using secondary health data:A systematic review

Objective:Prevention and early detection of colorectal cancer(CRC)can increase the chances of successful treatment and reduce burden.Various data mining technologies have been utilized to strengthen the early detection of CRC in primary care.Evidence synthesis on the model’s effectiveness is scant.This systematic review synthesizes studies that examine the effect of data mining on improving risk prediction of CRC.Methods:The PRISMA framework guided the conduct of this study.We obtained papers via Pub Med,Cochrane Library,EMBASE and Google Scholar.Quality appraisal was performed using Downs and Black’s quality checklist.To evaluate the performance of included models,the values of specificity and sensitivity were comparted,the values of area under the curve(AUC)were plotted,and the median of overall AUC of included studies was computed.Results:A total of 316 studies were reviewed for full text.Seven articles were included.Included studies implement techniques including artificial neural networks,Bayesian networks and decision trees.Six articles reported the overall model accuracy.Overall,the median AUC is 0.8243[interquartile range(IQR):0.8050-0.8886].In the two articles that reported comparison results with traditional models,the data mining method performed better than the traditional models,with the best AUC improvement of 10.7%.Conclusions:The adoption of data mining technologies for CRC detection is at an early stage.Limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the techniques’effects.

The public-private partnerships in healthcare sector in China

This manuscript is a narrative review on experience in the healthcare public-private partnerships(PPP)field project in China.The PPP model allows healthcare officials to share the risk of building new facilities with the private sector.The objective of this study is to evaluate and to review the PPP of healthcare sector in China,and to investigate the critical success factors and best practice of PPP.We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures.The current study systematically reviewed the evolution and current status of public and private hospitals development in China,and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China,and to develop best practice models of PPP among hospitals of China.We found that the PPP organizations providing finance and political risk coverage,thus enabling specific PPP transactions to reach financial closure-potentially setting demonstration effects.Such PPPs may then contribute to improving access to infrastructure and social services,which drives economic growth and other optimal outcomes.