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The know-do gap in quality of health for chronic non-communicable diseases in rural China

Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the “know-do gap” between provider knowledge and practice. To determine whet...

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Autores principales: Meng, Sha, Wang, Qingzhi, Wu, Yuju, Xue, Hao, Li, Linhua, Ye, Ruixue, Chen, Yunwei, Pappas, Lucy, Akhtar, Muizz, Dill, Sarah-Eve, Sylvia, Sean, Zhou, Huan, Rozelle, Scott
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9435052/
https://www.ncbi.nlm.nih.gov/pubmed/36062129
http://dx.doi.org/10.3389/fpubh.2022.953881
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author Meng, Sha
Wang, Qingzhi
Wu, Yuju
Xue, Hao
Li, Linhua
Ye, Ruixue
Chen, Yunwei
Pappas, Lucy
Akhtar, Muizz
Dill, Sarah-Eve
Sylvia, Sean
Zhou, Huan
Rozelle, Scott
author_facet Meng, Sha
Wang, Qingzhi
Wu, Yuju
Xue, Hao
Li, Linhua
Ye, Ruixue
Chen, Yunwei
Pappas, Lucy
Akhtar, Muizz
Dill, Sarah-Eve
Sylvia, Sean
Zhou, Huan
Rozelle, Scott
author_sort Meng, Sha
collection PubMed
description Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the “know-do gap” between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.
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spelling pubmed-94350522022-09-02 The know-do gap in quality of health for chronic non-communicable diseases in rural China Meng, Sha Wang, Qingzhi Wu, Yuju Xue, Hao Li, Linhua Ye, Ruixue Chen, Yunwei Pappas, Lucy Akhtar, Muizz Dill, Sarah-Eve Sylvia, Sean Zhou, Huan Rozelle, Scott Front Public Health Public Health Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the “know-do gap” between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future. Frontiers Media S.A. 2022-08-18 /pmc/articles/PMC9435052/ /pubmed/36062129 http://dx.doi.org/10.3389/fpubh.2022.953881 Text en Copyright © 2022 Meng, Wang, Wu, Xue, Li, Ye, Chen, Pappas, Akhtar, Dill, Sylvia, Zhou and Rozelle. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Meng, Sha
Wang, Qingzhi
Wu, Yuju
Xue, Hao
Li, Linhua
Ye, Ruixue
Chen, Yunwei
Pappas, Lucy
Akhtar, Muizz
Dill, Sarah-Eve
Sylvia, Sean
Zhou, Huan
Rozelle, Scott
The know-do gap in quality of health for chronic non-communicable diseases in rural China
title The know-do gap in quality of health for chronic non-communicable diseases in rural China
title_full The know-do gap in quality of health for chronic non-communicable diseases in rural China
title_fullStr The know-do gap in quality of health for chronic non-communicable diseases in rural China
title_full_unstemmed The know-do gap in quality of health for chronic non-communicable diseases in rural China
title_short The know-do gap in quality of health for chronic non-communicable diseases in rural China
title_sort know-do gap in quality of health for chronic non-communicable diseases in rural china
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9435052/
https://www.ncbi.nlm.nih.gov/pubmed/36062129
http://dx.doi.org/10.3389/fpubh.2022.953881
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