Quality of care in large Chinese hospitals: an observational study

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 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.