Three essays in healthcare quality management via analytics

Abstract

This thesis aims to contribute to three distinct bodies of literature concerning healthcare quality management, healthcare analytics and information technology. Comprising of three essays, each essay focuses on a specific research question within the broader context of healthcare.

The first essay employs a multivariate regression analysis and appropriate model selection techniques to examine the relationship between macroeconomic development and a critical stroke performance measure, specifically the adherence rate to Intravenous Tissue Plasminogen Activator (IV-rt PA). Drawing on data from 980 hospitals across 31 provinces in China, the study identifies that Gross Regional Product (GRP) per capita has a significant and positive effect on IV-rt PA adherence, even after accounting for temporal effects and hospital characteristics. This essay provides policy implications for resource allocation and medical funding to address disparities in the utilization of IV-rt PA.

The second essay investigates regional disparities in multiple stroke performance measures. Utilizing detailed patient-level data from China, which encompasses 838,229 patients with acute ischemic stroke (AIS) from 1473 hospitals nationwide, the study reveals that overall care quality in southern China (regions with lower stroke prevalence) surpasses that in northern China (regions with higher stroke prevalence) as demarcated by a predefined stroke belt. Additionally, heterogeneous variations in adherence to individual stroke care performance measures are observed between southern and northern China, as well as among regions with different levels of economic development.

The third essay aims to explore the effect of health information technology on stroke care delivery. Despite stroke being the leading cause of death in China and imposing escalating costs on the healthcare system, adherence to recommended stroke care metrics has been suboptimal. The study examines the potential of a mobile clinical support system to enhance adherence and improve patient outcomes. Analyzing a comprehensive dataset comprising over 8,000 patients in China from 2015 to 2022, the research demonstrates that the implementation of the mobile clinical decision support system significantly increases physicians' adherence to treatments and reduces major adverse events for stroke patients. Notably, the impact persists even after discontinuation of the system. Furthermore, heterogeneous effects are observed, with greater improvements observed in lower-grade hospitals and hospitals with fewer personnel.