Teleconsultation Landscape of Class A Tertiary General Hospitals in China: Insights from a National Survey (Preprint)
Authors: Shao Huige , Xie Hebin , Liu Chaoyuan , Gao Yuan , Tang Li , Long Hao , Tang Peng , Li Xiuli , Zhang Yiyu 
Published: February 2024

BACKGROUND

Telemedicine has emerged as a potential solution to address the uneven distribution of medical resources. The extent to which Class A tertiary general hospitals in China offer teleconsultation services after the COVID-19 pandemic remains unclear, as does the teleconsultation volume of these hospitals and its associated factors.

OBJECTIVE

To provide insights into the status of teleconsultations in Class A tertiary general hospitals in China.

METHODS

Data related to Class A tertiary general hospitals in China were obtained via the Baidu search engine, hospital official WeChat accounts and applets from October 15, 2023, to January 15, 2024. Monthly teleconsultation volumes of the endocrinology department were collected for each hospital. We categorized the hospitals into three levels: Level 1 (hospitals with beds above 2500 or those ranking in the top 100), Level 2 (hospitals with beds between 1500 and 2500), and Level 3 (hospitals with beds below 1500). Differences among groups were assessed using Chi-square tests or a rank sum test. In the evaluation of associations of teleconsultation volume with hospital levels and charge levels, analysis stratified by city location (metropolitan or micropolitan) was also performed.

RESULTS

A total of 688 Class A tertiary general hospitals were included in the study. Of these, 69.5% (478/688) offered teleconsultation services. The proportion of hospitals providing teleconsultation services correlated with the hospital level and city location (both P<.001). Among the 380 hospitals with listed teleconsultation charges, 95 provided free teleconsultation services. Of the 285 hospitals charging for teleconsultation, the median charge was ¥15.0 (CNY ¥1=US $0.1398; IQR ¥8.0-¥25.0). Hospitals located in metropolitan areas charged higher than those in micropolitan areas (¥15.5[IQR ¥10.0-¥25.0] vs. ¥9.6[IQR ¥6.0-¥22.0], P<.001). The median monthly teleconsultation volume of endocrinology departments was 21.0 (IQR 3.0-101.5). Teleconsultation volume decreased with lower hospital levels (Level 1 vs. Level 2 vs. Level 3, 77.0[IQR 18.5-246.0] vs. 16.0[IQR 3.0-38.8] vs. 4.0[IQR 0-34.5], P<.001). Hospitals in metropolitan areas had higher teleconsultation volumes than those in micropolitan areas (58.0 [IQR 9.5-220.0] vs 12.0 [IQR 0.25-35.8], P<.001). Teleconsultation volume increased with charge levels (free group vs low charge group vs. higher charge group, 10.5[1.0-32.8] vs. 21.0[3.0-112.5] vs. 62.0 [8.0-199.0], P<.001). Stratified analysis showed that, regardless of metropolitan or micropolitan location, teleconsultation volume increased with hospital level (all P<.001). In metropolitan hospitals, teleconsultation volume increased with charge level (P<.001), while in the micropolitan group, no association was found between teleconsultation volume and charge level (P=.60).

CONCLUSIONS

Most Class A tertiary general hospitals in China provide teleconsultation services, often at low or no cost. However, our study highlights a relatively low teleconsultation volume, especially in smaller hospitals, those located in micropolitan areas, and those with low consultation charges. Further research is essential to address these challenges and facilitate the widespread adoption of telemedicine on a larger scale.