Background Kidney replacement therapy (KRT) is a lifesaving but costly treatment for patients with end-stage kidney disease (ESKD). The objective of this study was to review full economic evaluations comparing KRT modalities specified as hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) for patients with ESKD. Methods We conducted a systematic review of the literature from PubMed, Embase, EconLit (EBSCO),

Objective To explore whether quality control circle (QCC) is associated with hospital staff’s perceptions of patient safety culture (PSC). Design A cross-sectional survey in 12 public hospitals from October to December 2018 and a longitudinal survey in one public hospital from November 2017 to November 2018. Setting In 12 public hospitals from six provinces located in eastern, central and western of China, and one public hospital in eastern China. Participants In total, 811 and 102 hospital staff participated in the cross-sectional survey and the longitudinal survey, respectively. These participants included doctors, nurses, medical technicians and administrative staff. Main Outcome Measures Hospital staff’s perceptions of PSC were measured by the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. The association between QCC implementation and PSC was identified by univariate analysis and multiple linear regression analysis. Results Univariate analysis showed that the staff from hospitals that had implemented QCC received significantly higher HSOPSC scores than those from hospitals where QCC had not been implemented (3.73 ± 0.61 vs. 3.57 ± 0.41, P < 0.05). The QCC implementation was a significant predictor in the established multiple linear regression model. One year after QCC implementation, the hospital involved in the longitudinal survey scored higher in HSOPSC than before (3.75 ± 0.42 vs. 3.60 ± 0.36, P < 0.001). Conclusions QCC implementation was positively associated with PSC and the former could promote the establishment of the latter. It is suggested that QCC can play an active role in enhancing PSC so as to further improve patient safety management.

Purpose: To analyse the quality control circle (QCC) implementation status, tool modification and promotion in hospitals in mainland China. Methods: Data were collected from the 2013-2018 National Quality Control Circle Competition of Chinese Hospitals. A total of 1913 participating QCCs implemented by 34,023 hospital staff from 915 hospitals across 31 provinces and municipalities were included in this study to analyse the characteristics of QCC implementation status in mainland China, using descriptive analyses. Results: The majority of participating QCCs came from central and eastern hospitals. Most of the QCCs were carried out in tertiary hospitals and focused on themes of safety and patient care. The QCC has been modified in terms of its classification, implementation process, participation mechanism, and ways of dissemination. A series of promotion strategies have been made to promote the implementation of QCCs nationwide, including establishing a professional promotion organization, developing standardized training programmes, and organizing QCC academic events. Conclusion: After years of promotion, QCCs are widely used in hospitals and have been modified to fit the practice of healthcare institutions. The QCC promotion strategies in China can offer valuable insights for other countries that are also making efforts to continuously improve care quality in healthcare institutions.

ObjectivesThis study aims to assess the cost-effectiveness of three renal replacement therapy (RRT) modalities as well as proposed changes of scheduled policies in RRT composition in Guangzhou city.MethodsFrom a payer perspective, we designed Markov model-based cost-effectiveness analyses to compare the cost-effectiveness of three RRT modalities and four different scheduled policies to RRT modalities in Guangzhou over three time horizons (5, 10 and 15 years). The current situation (scenario 1: haemodialysis (HD), 73%; peritoneal dialysis (PD), 14%; kidney transplantation (TX), 13%) was compared with three different scenarios: an increased proportion of incident RRT patients on PD (scenario 2: HD, 47%; PD, 40%; TX, 13%); on TX (scenario 3: HD, 52%; PD, 14%; TX, 34%); on both PD and TX (Scenario 4: HD, 26%; PD, 40%; TX, 34%).ResultsOver 5-year time horizon, HD was dominated by PD. At a willingness-to-pay (WTP) threshold of US$44 300, TX was cost-effective compared with PD with an incremental cost-effectiveness ratio of US$35 518 per quality-adjusted life year (QALY) gained. The scenario 2 held a dominant position over the scenario 1, with a net saving of US$ 5.92 million and an additional gain of 6.24 QALYs. The scenarios 3 and 4 were cost-effective compared with scenario 1 at a WTP threshold of US$44 300. The above results were consistent across the three time horizons.ConclusionsTX is the most cost-effective RRT modality, followed in order by PD and HD. The strategy with an increased proportion of incident patients on PD and TX is cost-effective compared with the current practice pattern at the given WTP threshold. The planning for RRT service delivery should incorporate efforts to increase the utilisation of PD and TX in China.

Background: The increase in elective surgeries and varied postoperative patient outcomes has boosted the use of patient decision support interventions (PDSIs). However, evidence on the effectiveness of PDSIs are not updated. This systematic review aims to summarize the effects of PDSIs for surgical candidates considering elective surgeries and to identify their moderators with an emphasis on the type of targeted surgery. Design: Systematic review and meta-analysis. Methods: We searched eight electronic databases for randomized controlled trials evaluating PDSIs among elective surgical candidates. We documented the effects on invasive treatment choice, decision-making–related outcomes, patient-reported outcomes, and healthcare resource use. The Cochrane Risk of Bias Tool version 2 and Grading of Recommendations, Assessment, Development, and Evaluations were adopted to rate the risk of bias of individual trials and certainty of evidence, respectively. STATA 16 software was used to conduct the meta-analysis. Results: Fifty-eight trials comprising 14 981 adults from 11 countries were included. Overall, PDSIs had no effect on invasive treatment choice (risk ratio=0.97; 95% CI: 0.90, 1.04), consultation time (mean difference=0.04 min; 95% CI: −0.17, 0.24), or patient-reported outcomes, but had a beneficial effect on decisional conflict (Hedges’ g=−0.29; 95% CI: −0.41, −0.16), disease and treatment knowledge (Hedges’ g=0.32; 95% CI: 0.15, 0.49), decision-making preparedness (Hedges’ g=0.22; 95% CI: 0.09, 0.34), and decision quality (risk ratio=1.98; 95% CI: 1.15, 3.39). Treatment choice varied with surgery type and self-guided PDSIs had a greater effect on disease and treatment knowledge enhancement than clinician-delivered PDSIs. Conclusions: This review has demonstrated that PDSIs targeting individuals considering elective surgeries had benefited their decision-making by reducing decisional conflict and increasing disease and treatment knowledge, decision-making preparedness, and decision quality. These findings may be used to guide the development and evaluation of new PDSIs for elective surgical care.