Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey

Abstract

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.Methods and analysis1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.Ethics and disseminationThis study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.

NUrse-led COntinuum of care for people with Diabetes and prediabetes (NUCOD) in Nepal: study protocol for a cluster randomized controlled trial

“…Implementation will examine the fidelity and quality of the program execution per protocol. To check program fidelity, we will select and train standardized patients (SPs) from the program participants with stable conditions-these SPs will serve as the "secret agents" and the sentry to assess program fidelity with a quality checklist through their routine encounters with the clinicians at the DH diabetes clinic and the nurses; the clinicians will be blinded to the status of the SPs; and the development of SPs and the checklist will follow the protocol we have developed in a separate study [34].…”

Nurse-led continuum of care for people with diabetes and pre-diabetes in Nepal (NUCOD): study protocol for a cluster randomized controlled trial

“…The clinicians will be blinded to the status of the SPs. The development of SP and checklist will follow the protocol we have developed in a separate study [34]. (5) Maintenance will not be assessed for the purpose of this study.…”

Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China

“…This is one of a series of studies (ACACIA (Primary heAlth Care quAlity Cohort In chinA) study: https://www.researchgate.net/project/ACACIA-Study ) using USPs and smartphone-based virtual patients in assessing and understanding the quality of PHC in a random sample of primary care facilities in seven provinces of China. 29 30 In this particular study, our purpose is to explore the association of the ownership types of the providers to the quality of PHC, which includes two steps: (1) raw comparison of the quality of care between the private and public PHC providers using USPs so as to expose any objective quality differences between the two groups and (2) comparison after adjusting for potential confounding so as to isolate the relations between the intrinsic natures of the private ownership to quality of PHC.…”