title: Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China.
abstract: BACKGROUND
  In clinical practice, the physician's treatment decision making is influenced by many factors besides the patient's clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician's treatment choices.
  
  
  OBJECTIVE
  To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China.
  
  
  METHODS
  A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes.
  
  
  RESULTS
  Regardless of patients' clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non-reformed tertiary hospitals, reformed tertiary hospitals and county hospitals were less likely to give T2DM patients oral therapy (RRR = 0.07 and 0.1 respectively) and insulin therapy (RRR = 0.11 and 0.17 respectively).
  
  
  CONCLUSIONS
  Gender was the only socio-demographic factors associated with treatment scheme for T2DM patients. Hospitals from different regions have different T2DM treatment patterns. Implementation of reform was shown to be associated with controlling medication use for T2DM inpatients. Further studies are needed to investigate the causes of unreasonable treatment disparities so that policies can be generated accordingly.
authors.affiliation: School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand.
authors.forename: Edward
authors.initials: E
authors.lastname: McNeil
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand.
authors.forename: Sawitri
authors.initials: S
authors.lastname: Assanangkornchai
authors.affiliation: School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China.
authors.forename: Yancun
authors.initials: Y
authors.lastname: Fan
keywords: T2DM; Treatment scheme; healthcare disparities; hospital management; influence factors