Structure and Process Quality of Outpatient and Emergency Care in Primary Health Institutions: A Prospective, Observational Assessment from Jiangsu Province, China

Structure and Process Quality of Outpatient and Emergency Care in Primary Health Institutions: A Prospective, Observational Assessment from Jiangsu Province, China | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 18 October 2025 V1 Latest version Share on Structure and Process Quality of Outpatient and Emergency Care in Primary Health Institutions: A Prospective, Observational Assessment from Jiangsu Province, China Authors : CUI Xiaolong 0009-0007-5551-0007 , Qiyang ZHOU , Xiaomin ZHAO , Min WANG , Shijie JIA , Zhongquan TANG , Ting OU , Xinyu DAI , Jingqing YAO , Hong DIN , and Yuntao LI [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176076373.32562933/v1 160 views 78 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: As foundational units of China’s three-tiered medical care system, primary healthcare institutions are crucial for the effectiveness of the tiered healthcare delivery system. Outpatient and emergency services, characterized by high patient volumes and complex scenarios, are fundamental to patient safety and public trust in primary care. Assessing and improving their quality is therefore of paramount importance. Aim: This study aimed to assess the current quality status and explore the influencing factors of outpatient and emergency care in primary healthcare institutions in Jiangsu Province, China, based on the Donabedian structure-process-outcome model. Materials and Methods: A prospective, observational study was conducted in 62 primary healthcare institutions across 13 prefecture-level cities in Jiangsu Province between January and December 2024. Three core quality control indicators were investigated: Average Daily Patient Visits per Physician, Standardization Rate of Emergency Rescue Procedures, and Timeliness Rate of Critical Value Management. Data were sourced from a provincial quality control platform. Univariate analysis (Mann-Whitney U, Spearman, Chi-square tests) and multivariable analysis (multiple linear regression, binary logistic regression) were employed to identify factors associated with the quality indicators. Results: Significant disparities were observed among institutions. The median average daily patient visits per physician was 22.1, with 12.9% of institutions indicating overload (>30 visits). The median score for emergency rescue procedure standardization was 27.9 points, with 48.4% meeting the high-quality standard (≥28.0 points). The timeliness rate of critical value management was 100% in 82.3% of institutions, while 17.7% had delays. Multivariable analysis revealed that: Average Daily Patient Visits per Physician was negatively associated with the total number of physicians (β = -0.115, P < 0.001) but positively associated with the number of specialized departments (β = 0.422, P < 0.001). The Standardization Rate of Emergency Rescue Procedures was positively influenced by the proportion of technicians with an associate degree or higher (β = 0.371, P = 0.001) and the total number of physicians (β = 0.268, P = 0.039). The Timeliness Rate of Critical Value Management was significantly improved by a higher proportion of highly educated staff (OR = 1.082, P = 0.040) and a greater proportion of intermediate/senior technical personnel (OR = 1.054, P = 0.049). Discussion and Conclusion: The quality of outpatient and emergency care in primary institutions is heterogeneous and significantly influenced by human resource allocation and specialized department development. Optimizing the physician workforce structure, increasing the proportion of high-level personnel, and promoting appropriate specialized department development are key pathways to improving service efficiency and quality. Recommendations include adopting a ”general-specialty integrated” model and incorporating these quality indicators into performance evaluations. These findings provide empirical evidence for enhancing primary care quality, though further multi-province validation is warranted. Supplementary Material File (article.docx) Download 60.89 KB Information & Authors Information Version history V1 Version 1 18 October 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords donabedian model healthcare quality control human resource allocation primary healthcare institutions service efficiency Authors Affiliations CUI Xiaolong 0009-0007-5551-0007 The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Qiyang ZHOU The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Xiaomin ZHAO The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Min WANG The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Shijie JIA The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Zhongquan TANG The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Ting OU The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Xinyu DAI The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Jingqing YAO The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Hong DIN The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Yuntao LI [email protected] The Second Affiliated Hospital of Nanjing Medical University View all articles by this author Metrics & Citations Metrics Article Usage 160 views 78 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation CUI Xiaolong, Qiyang ZHOU, Xiaomin ZHAO, et al. Structure and Process Quality of Outpatient and Emergency Care in Primary Health Institutions: A Prospective, Observational Assessment from Jiangsu Province, China. Authorea . 18 October 2025. DOI: https://doi.org/10.22541/au.176076373.32562933/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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