Data_Sheet_1_Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China.docx

BackgroundImproving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China.MethodsUsing multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system.ResultsA total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = −1.03, 95%: −1.95, −0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly.ConclusionThe quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.

背景：随着全球范围内糖尿病发病率的不断上升，改善2型糖尿病（T2D）的治疗至关重要，这对于减轻和减少疾病负担具有关键意义。然而，针对这一主题，尤其是来自农村地区的研究相对有限。本研究采用标准化病人（SP）评估农村中国基层医疗机构对T2D的治疗质量，以评估该地区的医疗保健系统。方法：通过多阶段随机抽样，选择了医疗机构、提供者和家庭。使用标准化病人评估提供者的T2D治疗质量，并使用问卷调查收集家庭中的患者分类行为。采用逻辑回归探索与T2D治疗质量相关的因素。将提供者的转诊和治疗率与患者的分类行为相结合，以评估中国农村医疗保健系统对T2D管理的整体质量。结果：共有126名提供者、106家机构和750户家庭参与了本研究。在标准化病人互动过程中，20%的农村提供者遵循了国家T2D咨询指南，32.5%提供了正确的治疗，54.7%提供了生活方式建议。多变量回归结果显示，持有执业证书的提供者（β = 1.56，95% CI：0.44，2.69）和看诊患者数量较多的提供者（β = 0.77，95%：0.25，1.28）更有可能使用推荐问题的更多数量，并执行更好的检查，而参与在线培训的提供者不太可能实践这些行为（β = −1.03，95%：−1.95，−0.11）。推荐问题的数量和检查（NRQE）是唯一与正确治疗显著相关的因素（边际效应 = 0.05，95%：0.01，0.08）。在整个农村医疗保健系统中，23.7%的T2D患者得到了正确的治疗。结论：中国西部农村地区T2D的治疗质量较差，尤其是在患者首次就诊的咨询和治疗过程中。在线培训可能无法提高T2D的治疗质量，而患者数量少可能表明治疗质量低下。需要进一步研究以探索改善中国农村医疗保健系统中T2D治疗质量的干预措施。