title: Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study.
abstract: BACKGROUND
  In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China.
  
  
  METHODS
  This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach.
  
  
  RESULTS
  The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site.
  
  
  CONCLUSIONS
  The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service.
authors.affiliation: The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.forename: John D
authors.initials: JD
authors.lastname: Walley
authors.forename: Jia
authors.initials: J
authors.lastname: Yin
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
mesh_terms: D002681:China; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D014376:Tuberculosis / Q000517:prevention & control / Q000628:therapy*