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A Comparative Study of Liver Disease Care in the USA and Urban and Rural China

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Abstract

Background

Chronic liver disease is a major cause of morbidity and mortality in the USA and China, but the etiology of liver disease, medical practice, and patient expectations in these two countries are different.

Aims

To compare patient knowledge about their liver disease, patient satisfaction with liver disease care, and patient medical decision-making preference in the USA and China.

Methods

Three cohorts of established adult patients with liver disease seen in liver clinics in Ann Arbor, USA, and Bei**g (urban) and Hebei (rural), China, completed a survey between May and September 2014.

Results

A total of 990 patients (395 USA, 398 Bei**g, and 197 Hebei) were analyzed. Mean liver disease knowledge score (maximum 5) in the USA, Bei**g, and Hebei patients was 4.1, 3.6, and 3.0, respectively (p < 0.001). US patients had a greater preference for collaborative decision-making: 71.8 % preferred to make treatment decisions together with the doctor, while most Chinese patients (74.6 % Bei**g and 84.8 % Hebei) preferred passive decision-making. Mean satisfaction score (maximum 85) in the USA was higher than in Bei**g, which in turn was higher than in Hebei (78.2 vs. 66.5 vs. 60.3, p < 0.001). There was a positive correlation between liver disease knowledge score and satisfaction score (r = 0.27, p < 0.001) and with collaborative medical decision-making (r = 0.22, p < 0.001) when responses from all sites were combined.

Conclusions

Liver disease knowledge and patient satisfaction were greatest in the USA, followed by Bei**g and then Hebei patients. Understanding these differences and associated factors may help to improve patient outcomes.

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Acknowledgments

Ming Yang was supported by US National Institutes of Health Research Training Grant 3R25TW009345 awarded to the Northern Pacific Global Health Fellows Program by the Fogarty International Center and Institutes. Fanny H. Du was supported by the University of Michigan Medical School Faculty-Led Global Reach Program for medical students. Angela **e, Cassandra Rodd, and Shanna Cheng are undergraduate students supported by the Alice Lohrman Andrews Research Professorship (to Anna S. Lok). Lai Wei and Anna S. Lok are supported by grants from the University of Michigan Health System and Peking University Health Science Center Joint Institute for Clinical and Translational Research.

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Authors and Affiliations

  1. Hepatology Institute, Peking University People’s Hospital, Peking University Health Science Center, 11 South **zhimen St, Bei**g, 100044, China

    Ming Yang, Huiying Rao & Lai Wei

  2. Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA

    Elizabeth Wu, Angela **e, Shanna Cheng, Cassandra Rodd & Anna S. Lok

  3. University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, 48109, USA

    Fanny H. Du

  4. The Molecular and Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Pl, Ann Arbor, MI, 48109, USA

    Andy Lin

  5. University of Michigan Health System, 1500 E Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109, USA

    Anna S. Lok

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  1. Ming Yang
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Correspondence to Anna S. Lok.

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Ming Yang, Elizabeth Wu, Huiying Rao, Fanny H. Du, Angela **e, Shanna Cheng, Cassandra Rodd, Andy Lin, Lai Wei, and Anna S. Lok declare that they have no conflict of interest related to this work.

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Yang, M., Wu, E., Rao, H. et al. A Comparative Study of Liver Disease Care in the USA and Urban and Rural China. Dig Dis Sci 61, 2847–2856 (2016). https://doi.org/10.1007/s10620-016-4206-2

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  • DOI: https://doi.org/10.1007/s10620-016-4206-2

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