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Quality of care in large Chinese hospitals: an observational study
  1. Weiyan Jian1,2,
  2. Jose Figueroa3,4,
  3. Liana Woskie5,6,
  4. Xi Yao1,
  5. Yuqi Zhou1,
  6. Zhengxiang Li7,
  7. Changan Li7,
  8. Li Yao8,
  9. Winnie C Yip9
  1. 1 Department of Health Policy and Management, Peking University Health Science Center School of Public Health, Beijing, China
  2. 2 Center for Health Policy and Technology Evaluation, Peking University Health Science Centre, Beijing, Beijing, China
  3. 3 Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5 Department of Health Policy, London School of Economics, London, UK
  6. 6 Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, USA
  7. 7 Outpatient Care Department, Shandong Province Hospital, Jinan, Shandong, China
  8. 8 Hospital Administration Research Institute, National Health Commission of China, Beijing, China
  9. 9 Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Weiyan Jian,Department of Health Policy and Management, Peking University Health Science Center School of Public Health, Beijing, China; jianweiyan{at}


Objective To empirically assess the quality of hospital care in China and trends over a 5-year period during which the government significantly increased its investment in healthcare.

Design Retrospective, observational study comparing hospital quality between two periods: October 2012–March 2013 and October 2017–March 2018.

Setting 1–2 of the most reputable large tertiary hospitals in each of the 25 provinces in Mainland China (total of 33).

Participants Adults 18 years or older admitted with acute myocardial infarction (AMI) (n = 7031), cerebral ischaemic stroke (n = 12 008), chronic obstructive pulmonary disease (COPD) (n = 11 836) and bacterial pneumonia (n = 4263).

Main outcome measures Process-based quality measures, including seven AMI measures, three stroke measures, four COPD measures and six pneumonia measures.

Results In 2012/2013, Chinese hospitals had variable performance on AMI measures, including prescribing aspirin on arrival (80.7%), and discharging patients on aspirin (79.2%), β-blockers (60.8%) or statins (75.8%). This was similar for stroke cases and pneumonia cases. Smoking cessation advice was given at high rates across conditions though rates of influenza/pneumococcal vaccines were performed <1%. In 2017/2018, Chinese hospitals experienced no differences across most quality measures. Performance declined for two measures: aspirin on arrival for AMI cases and blood cultures before antibiotics for pneumonia cases. Performance increased for two measures: percutaneous coronary intervention within 90 min in ST segment elevation myocardial infarction cases (66.6% vs 80.1%, p<0.001) and statins at discharge for stroke cases (64.7% vs 78.7%, p<0.001). Compared with US hospitals, Chinese hospitals underperformed across most measures.

Conclusions Chinese hospitals had low and variable performances across most quality measures for common medical conditions. Quality of care generally does not appear to be improving post national health reform. The Chinese government should include quality of care improvement in its health reform priorities to ensure patients receive appropriate and effective care.

  • healthcare quality
  • health reform
  • china
  • hospital care

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  • Contributors WJ led the design of the study and drafted the manuscript. JF participated in interpretation of results and drafting of the manuscript. LW contributed to data acquisition and participated in paper writing. XY, ZL and CL conducted data acquisition and statistical analysis. YZ participated in paper writing. LY participated in the study design and assisted in data collection. WCY guided WJ in the design of the study and contributed to writing of the manuscript. All authors have read and approved the final draft.

  • Funding This study was funded by China Medical Board (grant number: 16-259).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Peking University Institutional Review Board (IRB number: IRB00001052-18005).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

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