Top Health Service Concerns: A Data Mining Study of the Shanghai Health Hotline

Top Health Service Concerns: A Data Mining Study of the Shanghai Health Hotline | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Top Health Service Concerns: A Data Mining Study of the Shanghai Health Hotline Lili Shi, Tong Zhao, Shimiao Shi, Tianyu Tan, Aksara Regmi, Yuyang Cai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3594226/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Our study aims to explore the health service issues of public concern through analyzing the basic characteristics of callers and information from health service work orders. The findings of this study will provide a reference to relevant government departments and assist the government in optimizing the allocation of health resources. Methods We used 16,962 original work orders from the Health Hotline in Shanghai since 2015 as our research data. We applied natural language processing to analyze the work orders. We conducted data cleaning on the work orders' textual content, and established a work order database. We performed analysis on call duration, content, purpose, topic, and other dimensions, using the 12320 Health Hotline call records from Shanghai in 2015. Results Out of the calls, they were categorized into four main groups: complaints, suggestions, inquiries and requests for assistance. Among these calls, the most common category was complaints with a total of 8,669 (51.11%), followed by help-seeking with 3335 (19.66%), consulting with 2727 (16.08%) and comments and opinion suggestions with 1484 (8.75%). The analysis of the data also showed that 6,689 calls (56.88%) from men outnumbered 5,071 calls (43.12%) from women, with 2,126 calls from parents (56.84%) slightly outnumbered 1,614 calls from children (43.16%). Furthermore, the top 10 health service concerns in Shanghai included attitudes towards services, medications, fees, registration, family planning, medical disputes, ambulances, environmental health, illegal medical practices, and immunization. Conclusions The concerns reflected by the Shanghai Health Hotline mirror the genuine health service needs of residents, carrying significant implications for urban health governance. These top 10 health service concerns in Shanghai hold paramount importance. They provide valuable insights for relevant government departments to implement targeted measures aimed at enhancing the quality of health services. Health Hotline Text Mining Concerns of Health Service Urban Health Governance Health Policy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The Shanghai 12320 Health Hotline serves a vital role in addressing the burgeoning health needs of the general populace. Its objectives encompass disseminating health prevention knowledge, public health policies, laws, and regulations. It strives to respond to a diverse array of public health inquiries, enhance awareness of disease prevention, and provide health counsel to the public. Furthermore, it endeavors to guide the health-related behavior of residents, assisting them in cultivating a scientific and health-oriented lifestyle. The hotline also plays a crucial role in receiving and addressing complaints and reports about public health emergencies, offering medical guidance, and elucidating medical test reports [ 1 ] . The previous research on health hotlines has demonstrated the significant potential of health hotlines in improving citizens' health literacy, conducting public health surveillance and optimizing health resource allocation [ 2 – 6 ] . Analyzing the data from the Shanghai 12320 Health Hotline can provide a comprehensive understanding of residents' true health service needs and the primary issues affecting the health sector in Shanghai. By addressing these issues, relevant government departments can implement targeted measures to optimize the allocation of health resources [ 7 – 9 ] . Methods Data source In this study, we analyzed 16,926 original work orders from the 2015 records of the Shanghai Health Hotline, serving as our primary research dataset. These work orders, documented by hotline personnel, contained information on voice calls from citizens reporting various issues. Each work order had a unique identifier and included details such as call time, locations mentioned, content records, processing descriptions, and responses to the caller. Data cleaning Data cleaning is the prerequisite for data analysis. Initially, the text-based segments of the work orders underwent a desensitization process to protect the privacy of callers. We then handled missing values by removing seriously missing data such as "Document type." Following this, we carried out deduplication procedures to eliminate data that exhibited overlapping meanings, such as the duplication between "response to citizens' key points" and "completion report" in the work orders. Fields Included in the Analysis After the data cleaning process and thorough discussions among research team & 12320 technical experts, we have excluded fields that lack correlation, and fields with stronger correlation are retained as follows: (1) Call Time: Call time records the precise moment when the work order occurred, allowing us to track the distribution of incoming calls for work orders over 24 hours and across the 12 months of the year. (2) Caller gender: Caller gender indicates the gender of the individual making the call. (3) Caller object: The caller object captures the identity characteristics of the individual making the call, such as husband, wife, and parents, because occasionally, the caller may report issues related to family members rather than themselves. (4) Type: The purposes and contents of the calls could be divided into five categories: Complaint, Help-seeking, Consultation, Suggestion, and Others. (5) Descriptive Information: This field provides a context-specific description of the calls, including details of reported problems, the purpose of the calls, public appeals, and requests for responses from the call center. Natural language processing In text mining, words are fundamental semantic units that can be analyzed. To process the Chinese language, we employed the word segmentation method known as "No Dictionary Cutting Word." The specific processing process is shown in Fig. 1 . The "Descriptive Information" field documented detailed reports from residents regarding health service issues. We employed a commonly used thematic word algorithm model called "Latent Dirichlet Allocation" [ 10 ] . Additionally, we used "No Dictionary Cutting Word" technology and expert knowledge to process the original work orders. After the annotation of the corpus and the establishment of the corpus itself, to facilitate data analysis and ensure the scalability of research methodologies, it is imperative that the system can consistently recognize and perform identical computations. This study employed the Word2vec model to train word embeddings. Through the application of the Word2vec model, vector representations are acquired for each word. A paragraph comprising multiple words can be regarded as the summation of these word vectors, ultimately encapsulating each content description within a high-dimensional vector. The content is then categorized based on distinct thematic concerns and subsequently input into the LSTM model for training, facilitating the creation of a robust question classifier. This approach harnesses the power of machine learning to classify all content descriptions effectively. Result 1 Classification of work orders A comprehensive analysis was conducted on a total of 16,692 work orders of 2015 employing the methodology above. These work orders encompassed diverse content types, categorized into four primary categories: complaints, help-seeking, consultations, suggestions, and others. Among these, complaints constituted the majority, representing 8,669 (51.11%) work orders. The second-largest category of work orders was help-seeking, comprising 3,335 (19.66%), as illustrated in Table 1 . Table 1 Classification and quantity of call records of Shanghai Health Hotline in 2015 Classification quantity percent(%) Complaints 8669 51.11% Help-seeking 3335 19.66% Consulting 2727 16.08% Opinion suggestion 1484 8.75% Other 162 4.40% Total 16962 100.0% Subsequently, we conducted a more detailed analysis, specifically complaints, help-seeking, consultations, and suggestions. The top five sub-categories within each of these main categories are presented in Table 2 . Table 2 Sub-categories and Quantity of Shanghai Health Hotline call logs in 2015 Category Sub-categories Quantity Category Sub-categories Quantity Help-seeking Medical institutions and services 2879 Suggestions Medical institutions and services 1224 Population and family planning 166 Population and family planning 67 Public health agencies and services 94 Public health 60 Public health 91 Public health agencies and services 57 Medical reform policy 53 Medical reform policy 53 Complaints Medical institutions and services 7968 Consultation Seeking medical advice 944 Medical institutions and services 281 Population and family planning 875 Public health 245 Medical institutions and services 176 Population and family planning 79 Policies and regulations 139 About 12320 36 Medical reform policy 101 2 Call time statistics From a yearly perspective, December recorded the highest volume of calls, exceeding 1,800. Conversely, February had the lowest call volume, showing a fluctuating upward trend throughout the year, as shown in Fig. 2 . On a 24-hour basis, the peak number of calls answered is from 10 am-11 am, with busy periods from 9 am-12 am and 2 pm-4 pm, while small number of residents also call at night, as shown in Fig. 3 . 3. Analysis of callers Table 3 Gender distribution of caller objects Classification Male(%) Female(%) Complaint 3519(52.6%) 2385(47.0%) Consulting 1103(16.5%) 1126(22.2%) Help-seeking 1178(17.6%) 866(17.1%) Opinion suggestion 756(11.3%) 472(9.3%) Others 133(2.0%) 222(4.4%) Based on the call receiver's records, there were 6,762 male and 5,118 female callers. The records did not reflect the gender of the other callers; overall, there were more male than female callers, as illustrated in Table 3 . Data were compared by gender, and analyses were performed in Table 3 . The cross-tab shows that there are more male callers than female callers in the category of accusations and opinion suggestions and more female callers than male callers in the praise category. The results of the incoming caller analysis, as illustrated in Fig. 4 , reveal significant disparities in call patterns. Parents contributed a total of 2126 calls, while children accounted for 1614 calls. In contrast, the number of calls made by wives, at 264, was notably lower than those by husbands, who registered 879 calls. Importantly, the combined sum of calls from parents and children surpassed that of wives and husbands. 4 The top ten health service issues concerned by mostly public The findings, depicted in Fig. 5 , shed light on the top ten health service topics. These include service attitude, medication guidance, medical expenses, registration, family planning, medical disputes, ambulances, environmental health, illegal practice of medicine, and immunization. In 2015, the predominant content received by the hotline revolved around issues related to medical institutions and services, accounting for a significant 77.44% of all work orders. Citizens were primarily concerned with topics pertaining to medical institutions and services, such as service attitude, medical inquiries, fees, registration, and other aspects of medical services. Additionally, there were concerns related public health issues, including environmental health and vaccination. On the other hand, certain subjects, like family planning-related issues, arose from policy shifts, exemplified by the change from the one-child policy to the two-child policy. 4.1 Service attitude Among the top 10 health topics in 2015, the most frequently reported concern by citizens was the service attitude of medical staff, with only 12.8% of citizens calling to express positive review. The majority of citizens reported instances of poor attitudes. A more detailed analysis reveals that the issue of service attitude can be further categorized into two subtopics: "poor attitude" and "negligence of work." Calls labeled "poor attitude" predominantly occurred during patient-doctor visits. Citizens often described unfavorable attitudes exhibited by doctors and nurses, with occasional complaints directed at administrative staff. Calls regarding "poor attitude" frequently included phrases such as "refusing to engage in conversation," "disregarding patient concerns," "exhibiting an icy demeanor," "reluctance to provide explanations to citizens," "impatient behavior," and even where doctors failed to communicate with patients throughout the entirety of the visit. Some medical staff were reported to scold patients, raise their voices, or employ inappropriate language. The most prominent issue categorized as "negligence of work" was that doctors only appeared when patients had special conditions, and some medical staff even played on their phones during work hours, causing patients and families to struggle to locate doctors promptly. 4.2 Medication Guidance A total of 1,541 calls sought medical advice, primarily about four aspects: medical guidance (43.5%), drug purchases (33.4%), medication prescriptions (17.2%), and adverse drug reactions (5.9%). Citizen inquiries focused on asking for resources suitable for their conditions like departments or hospitals, inconvenience getting treatment on holidays, certain drugs being available at some hospitals or pharmacies but not at surrounding medical institutions, uncertainty on where to purchase discontinued or undersupplied cheaper drugs, and orphan drugs; undersupply of some drugs causing inconvenience and even needing to re-register at hospitals for prescriptions; questions concerning medication dosage and administration methods, especially for special populations like pregnant women and children, often related to medication guidelines. In addition, drug-food compatibility taboos and drug reactions were also involved, with citizens often asking about allergic reactions and adverse drug reactions like fever and vomiting after vaccination or medication. 4.3 Medical Expenses The primary concerns of citizens regarding fees encompassed issues related to "unreasonable fees," "extra charges," "refund problems," and "medical insurance payment problems." "Unreasonable fees" primarily referred to situations where certain examination items, treatments, or drugs at certain medical institutions exceeded what citizens had previously paid for similar services or the prices at other public hospitals. Consequently, patients perceived that the pricing mechanisms were not in compliance with regulations, leading to instances of unreasonable fees. "Extra charges" referred to situations where patients were billed for medical services or consumables they did not receive or use or where the quantity on the bill exceeded the patient's actual consumption. Complaints about refunds came from situations where citizens tried to get refunds after interrupting medical services for personal reasons, mainly citing complicated documentary evidence requirements, convoluted refund procedures, and long processing cycles. Complaints related to medical insurance payments were infrequent and sporadic, with no distinct, concentrated issues. The most frequently reported problem involved doctors prescribing non-covered, self-paid drugs without prior patient notification. 4.4 Registration The main issues reflected in the registration topic were "difficult registration," "scalper phenomenon," "appointment registration service," and "repeated registration." Citizens reported difficulty getting expert number. Eighty-seven calls mentioned the scalper phenomenon, complaining about scalpers reselling expert number near hospitals. Appointment registration issues were mainly inquiries on how to get slots and complaints about unsuccessful phone appointments, invalid online registrations, insufficient online registration quotas, and long waiting periods for appointment visits. "Repeated registration" referred to situations where patients had to register again (and pay again) on a subsequent day or at another time to undergo tests because the hospital could not arrange for the tests to be conducted on the same day as the original registration, often exceeding the 24-hour threshold. Citizens expressed discontent about having to incur repeated registration fees for this situation. 4.5 Family Planning Family planning became a hot health policy topic due to the roll out of the national two-child policy, with frequently appearing keywords like "family planning," "only child," and "second child." Citizens' calls were usually about family planning review procedures, the two-child policy, and newborn-related issues, with the family planning incentive policy accounting for the highest proportion at 47.6%. 4.6 Medical disputes Among various hospital departments, surgery, internal medicine, and obstetrics-gynecology ranked as the top three departments regarding dispute-related complaints, accounting for 28.7%, 25.7%, and 16.2% of complaints, respectively. These complaints predominantly stemmed from issues such as hospitals lacking humanized management, poor communication between medical staff and citizens, misdiagnosis, improper procedures, and other factors that triggered disputes. Hospitals also had problems like excessive treatment and medication, forcibly asking citizens to see specialist slots, carelessly giving children the wrong vaccines, and other malpractice. 4.7 Ambulance Concerns related to ambulances were often highlighted through keywords such as "ambulance" and "120." The main issues centered on long wait times for ambulances after calling the 120 emergency service, reluctance to address non-emergency calls, scarce ambulance availability, and situations where pre-booked ambulance services were later canceled or shifted to other tasks. 4.8 Environmental health Issues about environmental hygiene encompassed public smoking, water quality, noise, and indoor air pollution. Approximately 39.7% of calls were related to public smoking, with frequent complaints from malls, supermarkets, and restrooms. Water quality concerns accounted for 30.4% of calls, encompassing grievances about murky swimming pool water and filtered water quality. Noise-related complaints primarily originated from hospital renovations, the operation of large equipment (e.g., air-conditioners), and the loading and unloading of medical equipment (e.g., oxygen tanks). Indoor air pollution mainly revolved around formaldehyde contamination in newly decorated gyms and hospitals. Other environmental health concerns included hotel hygiene, lighting, mosquito infestations, restroom cleanliness, radiation, and more. 4.9 Illegal medical practice Illegal clinics usually have simple facilities and low technical capabilities. Citizens called to report clinics operating without medical qualifications - most commonly illegal dental clinics, followed by beauty and abortion clinics.The uneven distribution of medical resources creates a favorable environment for illicit medical practices to thrive. 4.10 Immunization Immunization-related calls could be categorized into inquiries and suggestions. Vaccination inquiries involved questions about institutions offering vaccinations, locations, operating hours, and related details. A few calls asked about getting vaccinations in different locations after moving. For allergy inquiries, citizens described suspected allergic reactions after vaccination and asked about possible side effects of the vaccines. The most frequently mentioned vaccines in these calls were Hepatitis B, flu, and varicella. Suggestion calls convey proposed ideas, such as establishing additional vaccination sites or extending vaccination hours to boost vaccination rates. Discussion Citizens were primarily concerned with topics pertaining to health institutions and services, "difficult and costly access to health services" is a challenge that China's medical system has always faced. The Chinese health system does not involve a strict general practitioner (GP) and referral system; therefore, patients in China can freely choose to attend any hospital [ 11 , 12 ] . Most people tend to choose doctors and hospitals (particularly top tertiary hospitals) with a good reputation regardless of disease type and severity; for example, patients with minor illnesses, common diseases, and chronic conditions can always choose the topmost hospitals and fail to be diverted to more appropriate primary medical institutions, which will make the medical experience of citizens very poor [ 13 , 14 ] . This, in turn, highlights the problem of 'difficult and costly access to health services' in China. Excessive workload and pressure can also lead to the deterioration of the medical staff's attitude, which may lead to medical disputes [ 15 ] . The results of this study show that "unreasonable fees" and "extra charges" are also hot issues for public complaints. In addition to service attitude, quality of medical service and doctor-patient relationship, cost is also an important factor that causes public dissatisfaction [ 16 – 21 ] . Studies have revealed that from 2010 to 2016 [ 22 – 27 ] , government subsidies accounted for only 7.71–9.13% of the total revenue for public hospitals. This highlights that public hospitals heavily rely on operational income, exacerbating doctors' tendencies to engage in "economic man" behaviors, including excessive treatment, inducement of medication, and unnecessary physical examinations [ 28 – 34 ] . When combined with patients' irrational health-seeking behaviors, this leads to unnecessary escalations in medical expenses [ 35 ] . Shanghai has already introduced relevant policies to address the health service issues citizens are concerned about. Policies include stipulating that a doctor can see a maximum of 40 patients per day, with a minimum consultation time of 10 minutes per patient [ 36 ] ; requiring top tertiary hospitals to reserve 30% of expert appointments for family doctors to improve the family doctor and referral system [ 37 ] ; cracking down on unreasonable charges, standardizing medical consultation procedures and others. To improve patient satisfaction, implement the "extended prescription" policy so that patients can obtain medications without going to tertiary hospitals [ 38 ] . In addition, relevant departments can also introduce targeted policies based on the problems discovered by the health hotlines, such as improving the medical supervision system, cracking down on behaviors like ticket scalping that disrupt appointment orders, providing preferential subsidies for drugs for rare diseases, and some special effect drugs to encourage manufacturers to continue production. In follow-up studies, in-depth analysis can be performed on health hotline data after policy implementation to evaluate the effects of policy implementation. Conclusion In terms of call time, taking a yearly perspective, the month of December recorded the highest volume of calls, and February witnessed the lowest call volume, showing a fluctuating upward trend throughout the year. As call objects, there were more male than female callers, and the total number of calls from parents and children was more than that of wives and husbands, indicating the intergenerational relationship, which is consistent with previous studies [ 39 ] . In 2015, the predominant content received by the hotline revolved around issues related to medical institutions and services, accounting for a significant 77.44% of all work orders. Citizens were primarily concerned with medical institutions and services, such as complaint about the service attitude of medical staff, complaint about unreasonable fees, extra charges, complaints about difficult registration, and scalper phenomenon; as well as medical guidance, drug purchase, drug consultation related medical consultation questions. In public health cases, most involve either complaints or inquiries. Complaints often concern environmental hygiene, with the public complaining about smoking in public places, unclean swimming pool water, and water quality issues with water purifiers. Inquiries mainly involve vaccination, with the public asking about vaccination locations and allergic reactions. Analyzing public calls to the Shanghai 12320 health hotline makes it possible to identify critical health service concerns promptly. Citizens' feedback and complaints can provide important feedback for health services and serve as valuable tools for improving the quality of health services [ 40 – 45 ] . Relevant departments should improve areas of concern based on hotline analysis to facilitate more effective allocation of health resources and improve urban health governance. As public awareness and endorsement of the hotline continue to increase, the staff should expand their knowledge base to address public complaints, inquiries, and requests, providing personalized health guidance and fully meeting the needs of the public. Limitations Our research relies solely on public calls to the hotline, which may overlook citizens who wish to provide feedback but do not call. Thus, there may be "survivor bias" in the research itself. Meanwhile, natural language processing still faces challenges in Chinese. Like a constructed language, a complete, finite set of rules cannot define the vast Chinese vocabulary and diverse sentences. There is also much ambiguity. Additionally, language processing often involves massive knowledge bases that are costly to build and maintain. Declarations Ethics approval and consent to participate The study confirmed that informed consent was obtained from all subjects. The research was approved by the medical ethical review committees at Shanghai Jiao Tong University School of Medicine (SJUPN-201904). All methodology and procedures were performed according to the recommendations and guidelines of the medical ethical review committees. Consent for publication Not applicable. Data Availability The data sets generated and analyzed during this study are not publicly available due to the sensitivity of the data but aggregate data used in joinpoint analyses are available from the corresponding author on reasonable request. Funding This study was supported by the National Social Science Foundation of China (Grant No. 17BSH056), and the Shanghai Jiao Tong University think tank leading research project (Grant No.ZKYJ-2020014). Contributions SLL, ZT and CYY contributed to the work’s conception, design, analysis, and interpretation of data. ZT and CYY led the survey development, implementation and analysis. All authors contributed to the interpretation of the data. TTY drafted the initial manuscript, and ZT and SSM and Aksara contributed to manuscript iterations. CYY revised it critically for important intellectual content. All authors approved the final version to be published. Competing interests The authors declare no competing interests. References Introduction to Shanghai 12320 health hotline：https://video.wsjkw.sh.gov.cn/bmfw/index.html Li, C C et al. 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Wofford MM, Wofford JL, Bothra J, et al. Patient complaints about physician behaviors: a qualitative study. Acad Med 2004;79:134–8. Jiang Y, Ying X, Zhang Q, et alManaging patient complaints in China: a qualitative study in ShanghaiBMJ Open 2014;4:e005131. doi: 10.1136/bmjopen-2014-005131 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3594226","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":251919501,"identity":"3d311e8c-6daf-473c-af5c-6ebef2a54720","order_by":0,"name":"Lili Shi","email":"","orcid":"","institution":"XinHua Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lili","middleName":"","lastName":"Shi","suffix":""},{"id":251919504,"identity":"801ed16c-6e56-4a54-819d-73124ea9f8a7","order_by":1,"name":"Tong Zhao","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Zhao","suffix":""},{"id":251919506,"identity":"8e13ce18-a272-4d1a-94ae-2d7418120322","order_by":2,"name":"Shimiao Shi","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shimiao","middleName":"","lastName":"Shi","suffix":""},{"id":251919507,"identity":"e145850f-0a55-4806-b36a-ab69e82c1186","order_by":3,"name":"Tianyu Tan","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tianyu","middleName":"","lastName":"Tan","suffix":""},{"id":251919509,"identity":"114ab784-2aa7-4a57-85a2-2b5cb0e63aac","order_by":4,"name":"Aksara Regmi","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aksara","middleName":"","lastName":"Regmi","suffix":""},{"id":251919512,"identity":"2b36d144-1f21-4a40-8e8b-49a73a129619","order_by":5,"name":"Yuyang Cai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYFACxgYIzd7AYABmHCBaC88BBoMDxGmBAYkEqGpCWvjbD7dJ87bZ5clHPn9Q/LGNQY7vRgLj5wJ8Zp9JBGlJLja8nWNgcLCNwVjyRgKz9Aw8WgwYwFqYEzfOzmEAaUnccCOBjZkHnxb+hyAt9YkbZx5/ANJST1iLBNiWw4nzJRjADkswIKRF4sbDZss5544nbuAB+uXMOQnDmWceNkvj08Lfn/7wxpuy6sT57cefGVSU2cjzHU8++BmfFiBgkWBkYwBFIxsw9iUYEJGLGzB/YPjDwCDfwMD8gJDSUTAKRsEoGJkAAMBtT9dm1eVUAAAAAElFTkSuQmCC","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yuyang","middleName":"","lastName":"Cai","suffix":""}],"badges":[],"createdAt":"2023-11-11 05:14:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3594226/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3594226/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":47075213,"identity":"59aa74b8-0ecf-42e5-bc20-bf3ee130528e","added_by":"auto","created_at":"2023-11-25 22:54:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64216,"visible":true,"origin":"","legend":"\u003cp\u003eText mining Process\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/a224f0384b578edc205b3418.jpg"},{"id":47075758,"identity":"5b003963-cdc4-4562-9810-2029607441df","added_by":"auto","created_at":"2023-11-25 23:02:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":70670,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly Statistics of Call Logs in 2015\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/9b7d589893a7f12f97c8efdb.jpg"},{"id":47075215,"identity":"16712afd-c852-43e6-9f09-977dbcc615e6","added_by":"auto","created_at":"2023-11-25 22:54:58","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71112,"visible":true,"origin":"","legend":"\u003cp\u003ePeriod statistics of call records in 2015\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/908e8d8b4b64704352a1f37d.jpg"},{"id":47076380,"identity":"fadc3b65-fb86-431d-8f22-d52d70779a3f","added_by":"auto","created_at":"2023-11-25 23:10:58","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":59231,"visible":true,"origin":"","legend":"\u003cp\u003eCaller objects of Shanghai 12320 Health Hotline in 2015\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/39ebf542eba55e1d833bd6e5.jpg"},{"id":47075217,"identity":"5854e772-fe1f-4dba-bdd3-82e028edc3cd","added_by":"auto","created_at":"2023-11-25 22:54:58","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":122362,"visible":true,"origin":"","legend":"\u003cp\u003eTop ten health service issues concerned by mostly public\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/2f177c5a3aa40500c5b83b9a.jpg"},{"id":55521350,"identity":"9be85da4-a26b-4d36-8a3f-b278fc3d3c92","added_by":"auto","created_at":"2024-04-29 14:05:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":739174,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3594226/v1/2b92f038-97f6-4167-a4da-330ea9a15eef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Top Health Service Concerns: A Data Mining Study of the Shanghai Health Hotline","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Shanghai 12320 Health Hotline serves a vital role in addressing the burgeoning health needs of the general populace. Its objectives encompass disseminating health prevention knowledge, public health policies, laws, and regulations. It strives to respond to a diverse array of public health inquiries, enhance awareness of disease prevention, and provide health counsel to the public. Furthermore, it endeavors to guide the health-related behavior of residents, assisting them in cultivating a scientific and health-oriented lifestyle. The hotline also plays a crucial role in receiving and addressing complaints and reports about public health emergencies, offering medical guidance, and elucidating medical test reports\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe previous research on health hotlines has demonstrated the significant potential of health hotlines in improving citizens' health literacy, conducting public health surveillance and optimizing health resource allocation\u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Analyzing the data from the Shanghai 12320 Health Hotline can provide a comprehensive understanding of residents' true health service needs and the primary issues affecting the health sector in Shanghai. By addressing these issues, relevant government departments can implement targeted measures to optimize the allocation of health resources\u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003eIn this study, we analyzed 16,926 original work orders from the 2015 records of the Shanghai Health Hotline, serving as our primary research dataset. These work orders, documented by hotline personnel, contained information on voice calls from citizens reporting various issues. Each work order had a unique identifier and included details such as call time, locations mentioned, content records, processing descriptions, and responses to the caller.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData cleaning\u003c/h2\u003e \u003cp\u003eData cleaning is the prerequisite for data analysis. Initially, the text-based segments of the work orders underwent a desensitization process to protect the privacy of callers. We then handled missing values by removing seriously missing data such as \"Document type.\" Following this, we carried out deduplication procedures to eliminate data that exhibited overlapping meanings, such as the duplication between \"response to citizens' key points\" and \"completion report\" in the work orders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eFields Included in the Analysis\u003c/h2\u003e \u003cp\u003eAfter the data cleaning process and thorough discussions among research team \u0026amp; 12320 technical experts, we have excluded fields that lack correlation, and fields with stronger correlation are retained as follows:\u003c/p\u003e \u003cp\u003e(1) Call Time: Call time records the precise moment when the work order occurred, allowing us to track the distribution of incoming calls for work orders over 24 hours and across the 12 months of the year.\u003c/p\u003e \u003cp\u003e(2) Caller gender: Caller gender indicates the gender of the individual making the call.\u003c/p\u003e \u003cp\u003e(3) Caller object: The caller object captures the identity characteristics of the individual making the call, such as husband, wife, and parents, because occasionally, the caller may report issues related to family members rather than themselves.\u003c/p\u003e \u003cp\u003e(4) Type: The purposes and contents of the calls could be divided into five categories: Complaint, Help-seeking, Consultation, Suggestion, and Others.\u003c/p\u003e \u003cp\u003e(5) Descriptive Information: This field provides a context-specific description of the calls, including details of reported problems, the purpose of the calls, public appeals, and requests for responses from the call center.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eNatural language processing\u003c/h2\u003e \u003cp\u003eIn text mining, words are fundamental semantic units that can be analyzed. To process the Chinese language, we employed the word segmentation method known as \"No Dictionary Cutting Word.\" The specific processing process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe \"Descriptive Information\" field documented detailed reports from residents regarding health service issues. We employed a commonly used thematic word algorithm model called \"Latent Dirichlet Allocation\" \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Additionally, we used \"No Dictionary Cutting Word\" technology and expert knowledge to process the original work orders.\u003c/p\u003e \u003cp\u003eAfter the annotation of the corpus and the establishment of the corpus itself, to facilitate data analysis and ensure the scalability of research methodologies, it is imperative that the system can consistently recognize and perform identical computations. This study employed the Word2vec model to train word embeddings. Through the application of the Word2vec model, vector representations are acquired for each word. A paragraph comprising multiple words can be regarded as the summation of these word vectors, ultimately encapsulating each content description within a high-dimensional vector. The content is then categorized based on distinct thematic concerns and subsequently input into the LSTM model for training, facilitating the creation of a robust question classifier. This approach harnesses the power of machine learning to classify all content descriptions effectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1 Classification of work orders\u003c/h2\u003e \u003cp\u003eA comprehensive analysis was conducted on a total of 16,692 work orders of 2015 employing the methodology above. These work orders encompassed diverse content types, categorized into four primary categories: complaints, help-seeking, consultations, suggestions, and others. Among these, complaints constituted the majority, representing 8,669 (51.11%) work orders. The second-largest category of work orders was help-seeking, comprising 3,335 (19.66%), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification and quantity of call records of Shanghai Health Hotline in 2015\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercent(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplaints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelp-seeking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.66%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsulting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOpinion suggestion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.75%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSubsequently, we conducted a more detailed analysis, specifically complaints, help-seeking, consultations, and suggestions. The top five sub-categories within each of these main categories are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSub-categories and Quantity of Shanghai Health Hotline call logs in 2015\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCategory\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSub-categories\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eQuantity\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eCategory\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSub-categories\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eQuantity\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eHelp-seeking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMedical institutions and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eSuggestions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedical institutions and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePopulation and family planning\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePopulation and family planning\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePublic health agencies and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePublic health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePublic health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePublic health agencies and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMedical reform policy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedical reform policy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eComplaints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMedical institutions and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eConsultation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSeeking medical advice\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMedical institutions and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePopulation and family planning\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePublic health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedical institutions and services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePopulation and family planning\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePolicies and regulations\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAbout 12320\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedical reform policy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2 Call time statistics\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom a yearly perspective, December recorded the highest volume of calls, exceeding 1,800. Conversely, February had the lowest call volume, showing a fluctuating upward trend throughout the year, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOn a 24-hour basis, the peak number of calls answered is from 10 am-11 am, with busy periods from 9 am-12 am and 2 pm-4 pm, while small number of residents also call at night, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3. Analysis of callers\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGender distribution of caller objects\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplaint\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3519(52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2385(47.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsulting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1103(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1126(22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelp-seeking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1178(17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e866(17.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOpinion suggestion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e756(11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e472(9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOthers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e133(2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222(4.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the call receiver's records, there were 6,762 male and 5,118 female callers. The records did not reflect the gender of the other callers; overall, there were more male than female callers, as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eData were compared by gender, and analyses were performed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The cross-tab shows that there are more male callers than female callers in the category of accusations and opinion suggestions and more female callers than male callers in the praise category.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of the incoming caller analysis, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, reveal significant disparities in call patterns. Parents contributed a total of 2126 calls, while children accounted for 1614 calls. In contrast, the number of calls made by wives, at 264, was notably lower than those by husbands, who registered 879 calls. Importantly, the combined sum of calls from parents and children surpassed that of wives and husbands.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4 The top ten health service issues concerned by mostly public\u003c/h2\u003e \u003cp\u003eThe findings, depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, shed light on the top ten health service topics. These include service attitude, medication guidance, medical expenses, registration, family planning, medical disputes, ambulances, environmental health, illegal practice of medicine, and immunization.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn 2015, the predominant content received by the hotline revolved around issues related to medical institutions and services, accounting for a significant 77.44% of all work orders. Citizens were primarily concerned with topics pertaining to medical institutions and services, such as service attitude, medical inquiries, fees, registration, and other aspects of medical services. Additionally, there were concerns related public health issues, including environmental health and vaccination. On the other hand, certain subjects, like family planning-related issues, arose from policy shifts, exemplified by the change from the one-child policy to the two-child policy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Service attitude\u003c/h2\u003e \u003cp\u003eAmong the top 10 health topics in 2015, the most frequently reported concern by citizens was the service attitude of medical staff, with only 12.8% of citizens calling to express positive review. The majority of citizens reported instances of poor attitudes. A more detailed analysis reveals that the issue of service attitude can be further categorized into two subtopics: \"poor attitude\" and \"negligence of work.\"\u003c/p\u003e \u003cp\u003eCalls labeled \"poor attitude\" predominantly occurred during patient-doctor visits. Citizens often described unfavorable attitudes exhibited by doctors and nurses, with occasional complaints directed at administrative staff. Calls regarding \"poor attitude\" frequently included phrases such as \"refusing to engage in conversation,\" \"disregarding patient concerns,\" \"exhibiting an icy demeanor,\" \"reluctance to provide explanations to citizens,\" \"impatient behavior,\" and even where doctors failed to communicate with patients throughout the entirety of the visit. Some medical staff were reported to scold patients, raise their voices, or employ inappropriate language. The most prominent issue categorized as \"negligence of work\" was that doctors only appeared when patients had special conditions, and some medical staff even played on their phones during work hours, causing patients and families to struggle to locate doctors promptly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Medication Guidance\u003c/h2\u003e \u003cp\u003eA total of 1,541 calls sought medical advice, primarily about four aspects: medical guidance (43.5%), drug purchases (33.4%), medication prescriptions (17.2%), and adverse drug reactions (5.9%). Citizen inquiries focused on asking for resources suitable for their conditions like departments or hospitals, inconvenience getting treatment on holidays, certain drugs being available at some hospitals or pharmacies but not at surrounding medical institutions, uncertainty on where to purchase discontinued or undersupplied cheaper drugs, and orphan drugs; undersupply of some drugs causing inconvenience and even needing to re-register at hospitals for prescriptions; questions concerning medication dosage and administration methods, especially for special populations like pregnant women and children, often related to medication guidelines. In addition, drug-food compatibility taboos and drug reactions were also involved, with citizens often asking about allergic reactions and adverse drug reactions like fever and vomiting after vaccination or medication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Medical Expenses\u003c/h2\u003e \u003cp\u003eThe primary concerns of citizens regarding fees encompassed issues related to \"unreasonable fees,\" \"extra charges,\" \"refund problems,\" and \"medical insurance payment problems.\" \"Unreasonable fees\" primarily referred to situations where certain examination items, treatments, or drugs at certain medical institutions exceeded what citizens had previously paid for similar services or the prices at other public hospitals. Consequently, patients perceived that the pricing mechanisms were not in compliance with regulations, leading to instances of unreasonable fees. \"Extra charges\" referred to situations where patients were billed for medical services or consumables they did not receive or use or where the quantity on the bill exceeded the patient's actual consumption. Complaints about refunds came from situations where citizens tried to get refunds after interrupting medical services for personal reasons, mainly citing complicated documentary evidence requirements, convoluted refund procedures, and long processing cycles. Complaints related to medical insurance payments were infrequent and sporadic, with no distinct, concentrated issues. The most frequently reported problem involved doctors prescribing non-covered, self-paid drugs without prior patient notification.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Registration\u003c/h2\u003e \u003cp\u003eThe main issues reflected in the registration topic were \"difficult registration,\" \"scalper phenomenon,\" \"appointment registration service,\" and \"repeated registration.\" Citizens reported difficulty getting expert number. Eighty-seven calls mentioned the scalper phenomenon, complaining about scalpers reselling expert number near hospitals. Appointment registration issues were mainly inquiries on how to get slots and complaints about unsuccessful phone appointments, invalid online registrations, insufficient online registration quotas, and long waiting periods for appointment visits. \"Repeated registration\" referred to situations where patients had to register again (and pay again) on a subsequent day or at another time to undergo tests because the hospital could not arrange for the tests to be conducted on the same day as the original registration, often exceeding the 24-hour threshold. Citizens expressed discontent about having to incur repeated registration fees for this situation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Family Planning\u003c/h2\u003e \u003cp\u003eFamily planning became a hot health policy topic due to the roll out of the national two-child policy, with frequently appearing keywords like \"family planning,\" \"only child,\" and \"second child.\" Citizens' calls were usually about family planning review procedures, the two-child policy, and newborn-related issues, with the family planning incentive policy accounting for the highest proportion at 47.6%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Medical disputes\u003c/h2\u003e \u003cp\u003eAmong various hospital departments, surgery, internal medicine, and obstetrics-gynecology ranked as the top three departments regarding dispute-related complaints, accounting for 28.7%, 25.7%, and 16.2% of complaints, respectively. These complaints predominantly stemmed from issues such as hospitals lacking humanized management, poor communication between medical staff and citizens, misdiagnosis, improper procedures, and other factors that triggered disputes. Hospitals also had problems like excessive treatment and medication, forcibly asking citizens to see specialist slots, carelessly giving children the wrong vaccines, and other malpractice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Ambulance\u003c/h2\u003e \u003cp\u003eConcerns related to ambulances were often highlighted through keywords such as \"ambulance\" and \"120.\" The main issues centered on long wait times for ambulances after calling the 120 emergency service, reluctance to address non-emergency calls, scarce ambulance availability, and situations where pre-booked ambulance services were later canceled or shifted to other tasks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.8 Environmental health\u003c/h2\u003e \u003cp\u003eIssues about environmental hygiene encompassed public smoking, water quality, noise, and indoor air pollution. Approximately 39.7% of calls were related to public smoking, with frequent complaints from malls, supermarkets, and restrooms. Water quality concerns accounted for 30.4% of calls, encompassing grievances about murky swimming pool water and filtered water quality. Noise-related complaints primarily originated from hospital renovations, the operation of large equipment (e.g., air-conditioners), and the loading and unloading of medical equipment (e.g., oxygen tanks). Indoor air pollution mainly revolved around formaldehyde contamination in newly decorated gyms and hospitals. Other environmental health concerns included hotel hygiene, lighting, mosquito infestations, restroom cleanliness, radiation, and more.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.9 Illegal medical practice\u003c/h2\u003e \u003cp\u003eIllegal clinics usually have simple facilities and low technical capabilities. Citizens called to report clinics operating without medical qualifications - most commonly illegal dental clinics, followed by beauty and abortion clinics.The uneven distribution of medical resources creates a favorable environment for illicit medical practices to thrive.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.10 Immunization\u003c/h2\u003e \u003cp\u003eImmunization-related calls could be categorized into inquiries and suggestions. Vaccination inquiries involved questions about institutions offering vaccinations, locations, operating hours, and related details. A few calls asked about getting vaccinations in different locations after moving. For allergy inquiries, citizens described suspected allergic reactions after vaccination and asked about possible side effects of the vaccines. The most frequently mentioned vaccines in these calls were Hepatitis B, flu, and varicella. Suggestion calls convey proposed ideas, such as establishing additional vaccination sites or extending vaccination hours to boost vaccination rates.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCitizens were primarily concerned with topics pertaining to health institutions and services, \"difficult and costly access to health services\" is a challenge that China's medical system has always faced. The Chinese health system does not involve a strict general practitioner (GP) and referral system; therefore, patients in China can freely choose to attend any hospital \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Most people tend to choose doctors and hospitals (particularly top tertiary hospitals) with a good reputation regardless of disease type and severity; for example, patients with minor illnesses, common diseases, and chronic conditions can always choose the topmost hospitals and fail to be diverted to more appropriate primary medical institutions, which will make the medical experience of citizens very poor\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. This, in turn, highlights the problem of 'difficult and costly access to health services' in China. Excessive workload and pressure can also lead to the deterioration of the medical staff's attitude, which may lead to medical disputes\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of this study show that \"unreasonable fees\" and \"extra charges\" are also hot issues for public complaints. In addition to service attitude, quality of medical service and doctor-patient relationship, cost is also an important factor that causes public dissatisfaction\u003csup\u003e[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Studies have revealed that from 2010 to 2016\u003csup\u003e[\u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, government subsidies accounted for only 7.71\u0026ndash;9.13% of the total revenue for public hospitals. This highlights that public hospitals heavily rely on operational income, exacerbating doctors' tendencies to engage in \"economic man\" behaviors, including excessive treatment, inducement of medication, and unnecessary physical examinations\u003csup\u003e[\u003cspan additionalcitationids=\"CR29 CR30 CR31 CR32 CR33\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. When combined with patients' irrational health-seeking behaviors, this leads to unnecessary escalations in medical expenses\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eShanghai has already introduced relevant policies to address the health service issues citizens are concerned about. Policies include stipulating that a doctor can see a maximum of 40 patients per day, with a minimum consultation time of 10 minutes per patient\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e; requiring top tertiary hospitals to reserve 30% of expert appointments for family doctors to improve the family doctor and referral system\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e; cracking down on unreasonable charges, standardizing medical consultation procedures and others. To improve patient satisfaction, implement the \"extended prescription\" policy so that patients can obtain medications without going to tertiary hospitals\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. In addition, relevant departments can also introduce targeted policies based on the problems discovered by the health hotlines, such as improving the medical supervision system, cracking down on behaviors like ticket scalping that disrupt appointment orders, providing preferential subsidies for drugs for rare diseases, and some special effect drugs to encourage manufacturers to continue production. In follow-up studies, in-depth analysis can be performed on health hotline data after policy implementation to evaluate the effects of policy implementation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn terms of call time, taking a yearly perspective, the month of December recorded the highest volume of calls, and February witnessed the lowest call volume, showing a fluctuating upward trend throughout the year. As call objects, there were more male than female callers, and the total number of calls from parents and children was more than that of wives and husbands, indicating the intergenerational relationship, which is consistent with previous studies\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn 2015, the predominant content received by the hotline revolved around issues related to medical institutions and services, accounting for a significant 77.44% of all work orders. Citizens were primarily concerned with medical institutions and services, such as complaint about the service attitude of medical staff, complaint about unreasonable fees, extra charges, complaints about difficult registration, and scalper phenomenon; as well as medical guidance, drug purchase, drug consultation related medical consultation questions. In public health cases, most involve either complaints or inquiries. Complaints often concern environmental hygiene, with the public complaining about smoking in public places, unclean swimming pool water, and water quality issues with water purifiers. Inquiries mainly involve vaccination, with the public asking about vaccination locations and allergic reactions.\u003c/p\u003e \u003cp\u003eAnalyzing public calls to the Shanghai 12320 health hotline makes it possible to identify critical health service concerns promptly. Citizens' feedback and complaints can provide important feedback for health services and serve as valuable tools for improving the quality of health services\u003csup\u003e[\u003cspan additionalcitationids=\"CR41 CR42 CR43 CR44\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. Relevant departments should improve areas of concern based on hotline analysis to facilitate more effective allocation of health resources and improve urban health governance. As public awareness and endorsement of the hotline continue to increase, the staff should expand their knowledge base to address public complaints, inquiries, and requests, providing personalized health guidance and fully meeting the needs of the public.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur research relies solely on public calls to the hotline, which may overlook citizens who wish to provide feedback but do not call. Thus, there may be \"survivor bias\" in the research itself.\u003c/p\u003e \u003cp\u003eMeanwhile, natural language processing still faces challenges in Chinese. Like a constructed language, a complete, finite set of rules cannot define the vast Chinese vocabulary and diverse sentences. There is also much ambiguity. Additionally, language processing often involves massive knowledge bases that are costly to build and maintain.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study confirmed that informed consent was obtained from all subjects. The research was approved by the medical ethical review committees at Shanghai Jiao Tong University School of Medicine (SJUPN-201904). All methodology and procedures were performed according to the recommendations and guidelines of the medical ethical review committees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets generated and analyzed during this study are not publicly available due to the sensitivity of the data but aggregate data used in joinpoint analyses are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Social Science Foundation of China (Grant No. 17BSH056), and the Shanghai Jiao Tong University think tank leading research project (Grant No.ZKYJ-2020014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSLL, ZT and CYY contributed to the work\u0026rsquo;s conception, design, analysis, and interpretation of data. ZT and CYY led the survey development, implementation and analysis. All authors contributed to the interpretation of the data. TTY drafted the initial manuscript, and ZT and SSM and Aksara contributed to manuscript iterations. CYY revised it critically for important intellectual content. All authors approved the final version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eIntroduction to Shanghai 12320 health hotline：https://video.wsjkw.sh.gov.cn/bmfw/index.html\u003c/li\u003e\n\u003cli\u003eLi, C C et al. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] vol. 56,3 (2022): 397-400. doi:10.3760/cma.j.cn112150-20210729-00729\u003c/li\u003e\n\u003cli\u003eTolib Mirzoev \u0026amp; Sumit Kane (2018) Key strategies to improve systems for managing patient complaints within health facilities \u0026ndash; what can we learn from the existing literature?, Global Health Action, 11:1, DOI: 10.1080/16549716.2018.1458938\u003c/li\u003e\n\u003cli\u003eGlover-Kudon, Rebecca M, and Emily F Gates. \u0026ldquo;The Role of Quitlines in Tobacco Cessation: An Introduction.\u0026rdquo; American journal of preventive medicine vol. 60,3 Suppl 2 (2021): S99-S102. doi:10.1016/j.amepre.2020.12.003\u003c/li\u003e\n\u003cli\u003eQuint, J et al. \u0026ldquo;Workplace health hazards: analysis of hotline calls over a six-year period.\u0026rdquo; American journal of public health vol. 80,2 (1990): 202-4. doi:10.2105/ajph.80.2.202\u003c/li\u003e\n\u003cli\u003eCher, Benjamin A Y et al. \u0026ldquo;Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study.\u0026rdquo; Journal of medical Internet research vol. 23,11 e28105. 1 Nov. 2021, doi:10.2196/28105\u003c/li\u003e\n\u003cli\u003ei Casasnovas GL , Rivera B , Currais L . 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Practices and attitudes of doctors and patients to downward referral in Shanghai, China. BMJ Open. 2017;7(4):e012565.\u003c/li\u003e\n\u003cli\u003eWei M, Xiao JC. Study on influencing factors and countermeasures analyses of choosing different medical institutions by patients. Chin Health Serv Manage 2014;31:259\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eCentre for Health Statistics and Information, MOH China. Analysis report of National Health Services Survey in China. 2008.\u003c/li\u003e\n\u003cli\u003eShan, H P et al. \u0026ldquo;Overwork is a silent killer of Chinese doctors: a review of Karoshi in China 2013-2015.\u0026rdquo; Public health vol. 147 (2017): 98-100. doi:10.1016/j.puhe.2017.02.014\u003c/li\u003e\n\u003cli\u003eLiu, Ling, and Jinming Fang. \u0026ldquo;Study On Potential Factors Of Patient Satisfaction: Based On Exploratory Factor Analysis.\u0026rdquo; Patient preference and adherence vol. 13 1983-1994. 27 Nov. 2019, doi:10.2147/PPA.S228073\u003c/li\u003e\n\u003cli\u003eChen, Haiping et al. \u0026ldquo;Factors influencing inpatients\u0026apos; satisfaction with hospitalization service in public hospitals in Shanghai, People\u0026apos;s Republic of China.\u0026rdquo; Patient preference and adherence vol. 10 469-77. 4 Apr. 2016, doi:10.2147/PPA.S98095\u003c/li\u003e\n\u003cli\u003eQian, Hui et al. \u0026ldquo;Empirical Investigation on the Characteristics and Perceived Value of Patients in Medical Treatment Seeking: In-Depth Research in Zhejiang Province of China.\u0026rdquo; BioMed research international vol. 2021 5245041. 24 Dec. 2021, doi:10.1155/2021/5245041\u003c/li\u003e\n\u003cli\u003eZhang J. Investigation and analysis of medical disputes affecting doctors\u0026rsquo; understanding of doctor-patient relationship. Medicine and Philosophy: Humanities and Social Medicine Edition . 2010;31(11):41\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eXia Y., Zou Z., Zeng X. Cognition and attitude of medical staff to doctor-patient conflicts. China Health Care Management . 2013;6:413\u0026ndash;415. \u003c/li\u003e\n\u003cli\u003eHesketh T., Wu D., Mao L., Ma N. Violence against doctors in China. BMJ . 2012;345:p. e5730. doi: 10.1136/bmj.e5730. \u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2012. p. 2012.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2013. p. 2013.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2014. p. 2014.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2015. p. 2015.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2016. p. 2016.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of PRC. China Health and family planning statistical yearbook. Beijing: Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College Press; 2017. p. 2017.\u003c/li\u003e\n\u003cli\u003eRamesh M, Wu X. Health policy reform in China: lessons from Asia. Soc Sci Med. 2009;68(12):2256\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eZhao L, Yu G, Liu H, Ma X, Wang J, Kong G, Li Y, Ma W, Cui Y, Xu B, et al. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China. PloS one. 2013;8(8):e72166.\u003c/li\u003e\n\u003cli\u003eLiu L, Chen J. On the fulfillment of the commonweal\u0026rsquo;s nature of public hospitals. Chin Health Econ. 2015;3:47\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eYip WC-M, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet. 2010;375(9720):1120\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eZhao M, Ma J. Research on evaluation system and impact factors for public interest nature in public hospitals. J Shanghai Jiaotong University (Medical Science). 2009;29(6):737\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eZhang M, Wang W, Millar R, Li G, Yan F. Coping and compromise: a qualitative study of how primary health care providers respond to health reform in China. Hum Resour Health. 2017;15(1):50.\u003c/li\u003e\n\u003cli\u003eZhen A, Shen X, Ma Z. The responsibility of the government to safeguard the public welfare of public hospitals from the perspective of non-profit. Health Econ Res. 2016;4:18\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eYu W, Li M, Ye F, Xue C, Zhang L. Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study. BMJ Open. 2017;7(10):e016418.\u003c/li\u003e\n\u003cli\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844439/\u003c/li\u003e\n\u003cli\u003ehttps://wsjkw.sh.gov.cn/yzgl3/20230712/b0c3b2f09556480e950e0cd0b4ed28e3.html\u003c/li\u003e\n\u003cli\u003ehttps://www.sohu.com/a/324413649_100196148\u003c/li\u003e\n\u003cli\u003eElias RM, Fischer KM, Siddiqui MA, Coons T, Meyerhofer CA, Pretzman HJ, Greig HE, Stevens SK, Burton MC. A Taxonomic Review of Patient Complaints in Adult Hospital Medicine. J Patient Exp. 2021 Apr 8;8:23743735211007351. doi: 10.1177/23743735211007351. PMID: 34179414; PMCID: PMC8205411.\u003c/li\u003e\n\u003cli\u003eWinkler F. Complaints by patients. BMJ 1993;306:472\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eBaker R. Learning from complaints about general practitioners. BMJ 1999;318:1567\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSage WM. Putting the patient in patient safety: linking patient complaints and malpractice risk. JAMA 2002;287:3003\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eHsieh SY. A system for using patient complaints as a trigger to improve quality. Qual Manag Health Care 2011;20:343\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eWofford MM, Wofford JL, Bothra J, et al. Patient complaints about physician behaviors: a qualitative study. Acad Med 2004;79:134\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eJiang Y, Ying X, Zhang Q, et alManaging patient complaints in China: a qualitative study in ShanghaiBMJ Open 2014;4:e005131. doi: 10.1136/bmjopen-2014-005131\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Hotline, Text Mining, Concerns of Health Service, Urban Health Governance, Health Policy","lastPublishedDoi":"10.21203/rs.3.rs-3594226/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3594226/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eOur study aims to explore the health service issues of public concern through analyzing the basic characteristics of callers and information from health service work orders. The findings of this study will provide a reference to relevant government departments and assist the government in optimizing the allocation of health resources.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe used 16,962 original work orders from the Health Hotline in Shanghai since 2015 as our research data. We applied natural language processing to analyze the work orders. We conducted data cleaning on the work orders' textual content, and established a work order database. We performed analysis on call duration, content, purpose, topic, and other dimensions, using the 12320 Health Hotline call records from Shanghai in 2015.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of the calls, they were categorized into four main groups: complaints, suggestions, inquiries and requests for assistance. Among these calls, the most common category was complaints with a total of 8,669 (51.11%), followed by help-seeking with 3335 (19.66%), consulting with 2727 (16.08%) and comments and opinion suggestions with 1484 (8.75%). The analysis of the data also showed that 6,689 calls (56.88%) from men outnumbered 5,071 calls (43.12%) from women, with 2,126 calls from parents (56.84%) slightly outnumbered 1,614 calls from children (43.16%). Furthermore, the top 10 health service concerns in Shanghai included attitudes towards services, medications, fees, registration, family planning, medical disputes, ambulances, environmental health, illegal medical practices, and immunization.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe concerns reflected by the Shanghai Health Hotline mirror the genuine health service needs of residents, carrying significant implications for urban health governance. These top 10 health service concerns in Shanghai hold paramount importance. They provide valuable insights for relevant government departments to implement targeted measures aimed at enhancing the quality of health services.\u003c/p\u003e","manuscriptTitle":"Top Health Service Concerns: A Data Mining Study of the Shanghai Health Hotline","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-25 22:54:53","doi":"10.21203/rs.3.rs-3594226/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8be30c4-9e37-4337-9bca-baa9587caa24","owner":[],"postedDate":"November 25th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-29T12:26:10+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-25 22:54:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3594226","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3594226","identity":"rs-3594226","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}