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

doi:10.21203/rs.3.rs-3594226/v1

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

https://doi.org/10.21203/rs.3.rs-3594226/v1

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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

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].

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.

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.

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.

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.

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.

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No competing interests reported.

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

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Abstract

Objective

Methods

Results

Conclusions

Figures

Introduction

Methods

Data source

Data cleaning

Fields Included in the Analysis

Natural language processing

Result

1 Classification of work orders

2 Call time statistics

3. Analysis of callers

4 The top ten health service issues concerned by mostly public

4.1 Service attitude

4.2 Medication Guidance

4.3 Medical Expenses

4.4 Registration

4.5 Family Planning

4.6 Medical disputes

4.7 Ambulance

4.8 Environmental health

4.9 Illegal medical practice

4.10 Immunization

Discussion

Conclusion

Limitations

Declarations

References

Additional Declarations

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