How To Evaluate Traditional Chinese Medicine Characteristics In Traditional Chinese Medicine Hospitals

BackgroundTraditional Chinese medicine(TCM)is an essential component of the Chinese culture and has made outstanding contributions to the prosperity of the Chinese nation.Historically,TCM services were provided in the form of private therapy center or small clinics.Since the founding of the People’s Republic of China,public TCM hospitals have been established to provide professional TCM services.Although TCM hospitals in China are large in number and size,the current planning and development of TCM hospitals in China were heavily based on the framework of western medicine hospitals.The type of operation and culture that should be unique to the TCM hospitals has yet to be formalized in China,and the TCM characteristics have not been properly integrated in the clinical practice of these TCM hospitals.Since abundant evidence have shown that the hospital performance assessment can serve as the "baton" for the management of hospitals,a systematic evaluation of the TCM characteristics and the development of the TCM characteristics evaluation indicator set can promote the high-quality development of TCM hospitals while preserving the essence of TCM in the modern time.This study aimed to construct a set of indicators focusing on evaluating the TCM characteristics in TCM hospitals through concept formation,indicator construction,systematic and standardized evaluation practice.MethodsThis study follows the multi-stage design of mixed-method research paradigm.Through literature review and qualitative research methods,137 published manuscripts pertinent to TCM characteristics and 9 experts’ opinions were summarized.Through a new interpretation of the "structure-process-result" theory,an TCM characteristics indicator set was constructed by using the modified Delphi method(6 experts were invited to conduct two rounds of consultation),analytic hierarchy process and percentile-weight method.The indicator set was then applied to the survey data of 38 TCM hospitals(obtained from the China Healthcare Improvement Evaluation Survey)for validation.The original data was standardized.Results and discussionDefinition of TCM characteristicsThere is no consensus on the definition of TCM characteristics.This study synthesizes different expert opinions and summarizes the following three aspects.First,the advantage of TCM lies in its advanced health concept and dominant diseases,and the diagnosis and treatment scheme based on the holistic view and treatment based on syndrome differentiation;Second,it can synergize with modern medicine in different health or disease stages,to either enhance the treatment effect or reducing toxicity,such as the use of TCM decoction pieces and non-pharmaceutical therapy;Third,some of its own characteristics,such as characteristic talent training methods,etc.Construction of the indicator setThrough the renovative application of the classical theoretical framework of"structure-process-result" framework,an indicator pool of TCM characteristics was constructed.Structural indicators evaluate resource allocation of hospitals regarding integrating the characteristics of TCM in clinical practice.The process indicators assess the level of integration of the characteristics of TCM in the practice.The result indicators evaluate the benefits for the doctors,patients and the hospital after the provision of TCM characteristic services.Finally,a total of 3 first-level indicators,9 second-level indicators and 44 third-level indicators were included.Structural indicators include:TCM health manpower,department layout and equipment,provision of TCM services;the process indicators include:the quantity of TCM specialty service,TCM dominant diseases and their diagnosis and treatment standards,TCM talent training and cultural construction;the outcome indicators include:doctor and patient experience,hospital income from providing TCM services,and the number of patients treated in hospital.The weight setting result is as follows:structure 0.314,process 0.289,result 0.379.Experts have indicated that the outcome dimension had great influence on the characteristics of TCM.Application of the indicator setWe applied the indicator set on empirical research data and calculated the results for each sample hospital using standardized data and weight of sample hospitals,and then calculate the proportion of average index results in weight to get the scoring rate.Scoring rate results are as follows:structure dimension 36.1%,process dimension 31.0%,outcome dimension 37.9%.The results showed that the structural and outcome indicators of TCM generally had better performance,and the process indicators have more room for improvement.The score rate of the quantity of TCM specialty service in the process dimension(58.2%)and doctor-patient experience indicators in the outcome dimension(54.8%)exceeded 50%.The score rates of TCM talent training and cultural construction(13.2%)and TCM dominant diseases(19.2%)in the process dimension,as well as hospital income from providing TCM services(16.5%)were relatively low and had the largest room for improvement.ConclusionThis study focused on the measurement of TCM characteristics.Through summarizing experts’ opinions,this research added clarity in the definition of TCM characteristics and pushed the frontier of the scientific evaluation in TCM hospitals.This is the first study that quantifies the characteristics of TCM by constructing a weighted evaluation indicator set.Using real-world data,this study explored the performance of essential aspects of the TCM characteristics in the TCM hospitals,which could provide guidance to the future development of the TCM hospitals.By introducing indicators that had not valued enough previously in the evaluation of TCM hospitals,such as the number of talents in "Western doctors learn TCM" and TCM dominant diseases,and optimizing previously proposed indicators such as characteristic treatment space of TCM and "cure before disease",this study strived to promote the integration of TCM characteristics in the TCM hospitals by evaluating the TCM characteristics and explore the current strengths and weaknesses in the services.This study innovatively applied the "structure-process-outcome" framework to the evaluation of TCM characteristics,adopted mixed-method methodology to guide the design and implementation of the research,and filled the gap of lacking an evaluation indicator set for the TCM characteristics in TCM hospitals.At the same time,due to the small sample size in the validation dataset,further research is needed to optimizing the current evaluation indicators.This study also points out the need for more attention and investment on the TCM dominant diseases and TCM mentorship education by the government and hospitals.