{"id":"https://openalex.org/W7214965876","doi":"https://doi.org/10.1177/21501319261494128","title":"A Three-Year Longitudinal Analysis of Primary Care Quality Improvement Under a Regional Inspection Program in Shanghai: an Evaluation Using the PDSA Cycle as an Analytical Framework","display_name":"A Three-Year Longitudinal Analysis of Primary Care Quality Improvement Under a Regional Inspection Program in Shanghai: an Evaluation Using the PDSA Cycle as an Analytical Framework","publication_year":2026,"publication_date":"2026-09-01","ids":{"openalex":"https://openalex.org/W7214965876","doi":"https://doi.org/10.1177/21501319261494128","pmid":"https://pubmed.ncbi.nlm.nih.gov/42814037","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13735726"},"language":"en","primary_location":{"id":"doi:10.1177/21501319261494128","doi":"https://doi.org/10.1177/21501319261494128","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261494128","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care &amp; Community Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1177/21501319261494128","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5153620330","display_name":"Ying Liu","orcid":"https://orcid.org/0009-0007-2287-6889","observed_orcids":["https://orcid.org/0009-0007-2287-6889"]},"institutions":[{"id":"https://openalex.org/I183067930","display_name":"Shanghai Jiao Tong University","ror":"https://ror.org/0220qvk04","country_code":"CN","type":"education","lineage":["https://openalex.org/I183067930"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Ying Liu","raw_affiliation_strings":["Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine"],"raw_orcid":"https://orcid.org/0009-0007-2287-6889","affiliations":[{"raw_affiliation_string":"Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","institution_ids":["https://openalex.org/I183067930"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028393350","display_name":"Wenping Sun","orcid":"https://orcid.org/0000-0003-4626-4944","observed_orcids":["https://orcid.org/0000-0003-4626-4944"]},"institutions":[{"id":"https://openalex.org/I183067930","display_name":"Shanghai Jiao Tong University","ror":"https://ror.org/0220qvk04","country_code":"CN","type":"education","lineage":["https://openalex.org/I183067930"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Wenping Sun","raw_affiliation_strings":["Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine"],"raw_orcid":"https://orcid.org/0000-0003-4626-4944","affiliations":[{"raw_affiliation_string":"Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","institution_ids":["https://openalex.org/I183067930"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5153584709","display_name":"Qingqing Shi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I183067930","display_name":"Shanghai Jiao Tong University","ror":"https://ror.org/0220qvk04","country_code":"CN","type":"education","lineage":["https://openalex.org/I183067930"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Qingqing Shi","raw_affiliation_strings":["Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","institution_ids":["https://openalex.org/I183067930"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5153649438","display_name":"Hua Shen","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I183067930","display_name":"Shanghai Jiao Tong University","ror":"https://ror.org/0220qvk04","country_code":"CN","type":"education","lineage":["https://openalex.org/I183067930"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Hua Shen","raw_affiliation_strings":["Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","institution_ids":["https://openalex.org/I183067930"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5028393350"],"corresponding_institution_ids":["https://openalex.org/I183067930"],"apc_list":{"value":2500,"currency":"USD","value_usd":2500},"apc_paid":{"value":2500,"currency":"USD","value_usd":2500},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.69038076,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"17","issue":null,"first_page":"21501319261494128","last_page":"21501319261494128"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.7089999914169312,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.7089999914169312,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.28780001401901245,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10629","display_name":"Health Policy Implementation Science","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/primary-care-quality-improvement","display_name":"primary care quality improvement","score":0.9769999980926514},{"id":"https://openalex.org/keywords/pdsa-cycle","display_name":"PDSA cycle","score":0.7900000214576721},{"id":"https://openalex.org/keywords/community-health-centers","display_name":"community health centers","score":0.8679999709129333},{"id":"https://openalex.org/keywords/quality-indicators","display_name":"quality indicators","score":0.6129999756813049},{"id":"https://openalex.org/keywords/quality-management","display_name":"quality management","score":0.5130000114440918},{"id":"https://openalex.org/keywords/shanghai","display_name":"Shanghai","score":0.4869999885559082}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7820000052452087},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.7595999836921692},{"id":"https://openalex.org/C2781318095","wikidata":"https://www.wikidata.org/wiki/Q33127638","display_name":"General practice","level":2,"score":0.64410001039505},{"id":"https://openalex.org/C66882329","wikidata":"https://www.wikidata.org/wiki/Q820214","display_name":"PDCA","level":4,"score":0.5842000246047974},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.4927000105381012},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.4722000062465668},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.43299999833106995},{"id":"https://openalex.org/C2775951005","wikidata":"https://www.wikidata.org/wiki/Q3473024","display_name":"Community health","level":3,"score":0.41200000047683716},{"id":"https://openalex.org/C2777267654","wikidata":"https://www.wikidata.org/wiki/Q3519023","display_name":"Test (biology)","level":2,"score":0.4081000089645386},{"id":"https://openalex.org/C2775924081","wikidata":"https://www.wikidata.org/wiki/Q55608371","display_name":"Control (management)","level":2,"score":0.3968000113964081},{"id":"https://openalex.org/C163432668","wikidata":"https://www.wikidata.org/wiki/Q623543","display_name":"Primary health care","level":3,"score":0.39410001039505005},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.3743000030517578},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.3686000108718872},{"id":"https://openalex.org/C12725497","wikidata":"https://www.wikidata.org/wiki/Q810247","display_name":"Baseline (sea)","level":2,"score":0.3628000020980835},{"id":"https://openalex.org/C102366305","wikidata":"https://www.wikidata.org/wiki/Q1097688","display_name":"Nonparametric statistics","level":2,"score":0.36000001430511475},{"id":"https://openalex.org/C2780612607","wikidata":"https://www.wikidata.org/wiki/Q5155039","display_name":"Community practice","level":3,"score":0.35190001130104065},{"id":"https://openalex.org/C2982889124","wikidata":"https://www.wikidata.org/wiki/Q107439039","display_name":"Disease management","level":4,"score":0.351500004529953},{"id":"https://openalex.org/C116834253","wikidata":"https://www.wikidata.org/wiki/Q2039217","display_name":"Identification (biology)","level":2,"score":0.33719998598098755},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.32850000262260437},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.3154999911785126},{"id":"https://openalex.org/C138897024","wikidata":"https://www.wikidata.org/wiki/Q381001","display_name":"Total quality management","level":3,"score":0.31139999628067017},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.30640000104904175},{"id":"https://openalex.org/C135510737","wikidata":"https://www.wikidata.org/wiki/Q860554","display_name":"Performance indicator","level":2,"score":0.29670000076293945},{"id":"https://openalex.org/C2775936607","wikidata":"https://www.wikidata.org/wiki/Q466845","display_name":"Tracking (education)","level":2,"score":0.2930999994277954},{"id":"https://openalex.org/C2778915421","wikidata":"https://www.wikidata.org/wiki/Q3643177","display_name":"Performance improvement","level":2,"score":0.28949999809265137},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.28690001368522644},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2863999903202057},{"id":"https://openalex.org/C121272143","wikidata":"https://www.wikidata.org/wiki/Q17021791","display_name":"Health indicator","level":3,"score":0.2653999924659729},{"id":"https://openalex.org/C3020672099","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Longitudinal data","level":2,"score":0.2639999985694885},{"id":"https://openalex.org/C2780131953","wikidata":"https://www.wikidata.org/wiki/Q17003063","display_name":"Health care quality","level":3,"score":0.26010000705718994},{"id":"https://openalex.org/C88579808","wikidata":"https://www.wikidata.org/wiki/Q1046955","display_name":"Case mix index","level":2,"score":0.2587999999523163},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.25760000944137573},{"id":"https://openalex.org/C5395021","wikidata":"https://www.wikidata.org/wiki/Q1061410","display_name":"Program evaluation","level":2,"score":0.257099986076355},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.2517000138759613}],"mesh":[{"descriptor_ui":"D002681","descriptor_name":"China","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008137","descriptor_name":"Longitudinal Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011320","descriptor_name":"Primary Health Care","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D019984","descriptor_name":"Quality Indicators, Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D058006","descriptor_name":"General Practice","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D058996","descriptor_name":"Quality Improvement","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true}],"locations_count":4,"locations":[{"id":"doi:10.1177/21501319261494128","doi":"https://doi.org/10.1177/21501319261494128","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261494128","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care &amp; Community Health","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13735726","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13735726/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13735726/pdf/10.1177_21501319261494128.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"J Prim Care Community Health","raw_type":"Text"},{"id":"pmid:42814037","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42814037","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of primary care & community health","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:21b14dcf6ff94044960ca684db27399d","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/21b14dcf6ff94044960ca684db27399d","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Journal of Primary Care & Community Health, Vol 17 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1177/21501319261494128","doi":"https://doi.org/10.1177/21501319261494128","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261494128","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care &amp; Community Health","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9391000270843506,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214965876.pdf","grobid_xml":"https://content.openalex.org/works/W7214965876.grobid-xml"},"referenced_works_count":12,"referenced_works":["https://openalex.org/W2115133509","https://openalex.org/W3187705722","https://openalex.org/W4280527293","https://openalex.org/W4388441316","https://openalex.org/W4400961034","https://openalex.org/W4401638497","https://openalex.org/W6903565815","https://openalex.org/W6940991363","https://openalex.org/W7107958298","https://openalex.org/W7107962302","https://openalex.org/W7117234516","https://openalex.org/W7140179807"],"related_works":["https://openalex.org/W4389212300","https://openalex.org/W169158528","https://openalex.org/W6959979197","https://openalex.org/W3083087063","https://openalex.org/W839541791","https://openalex.org/W3100778658","https://openalex.org/W6977619008","https://openalex.org/W6958829379","https://openalex.org/W2784435775","https://openalex.org/W6993092032"],"abstract_inverted_index":{"ObjectiveThe":[0],"Plan-Do-Study-Act":[1],"(PDSA)":[2],"continuous":[3],"quality":[4,31,40,46,170,272,283,320],"improvement":[5,232],"theory":[6],"was":[7,24,122,148,186,285],"adopted":[8],"as":[9,66,103],"the":[10,34,67,90,131,152,163,189,192,207,237,243,255,258,264,268,288,291,314,328,334],"analytical":[11,14],"framework.":[12],"An":[13],"approach":[15],"combining":[16],"static":[17],"feature":[18],"identification":[19],"and":[20,80,119,137,139,147,156,174,198,216,252,293,322,330],"dynamic":[21],"trend":[22,153,278],"tracking":[23],"employed":[25,85],"to":[26,62,98,263,303],"describe":[27],"longitudinal":[28],"trends":[29],"in":[30,50,112,128,154,188,206,279],"indicators":[32],"during":[33],"implementation":[35],"of":[36,58,93,133,177,194,209,239,271,316,333],"regional":[37,94,280,317,335],"general":[38,44,95,115,168,178,336],"practice":[39,45,96,169,179,337],"control":[41,47,273],"inspections.MethodsData":[42],"from":[43,60],"inspections":[48],"conducted":[49],"18":[51,244],"community":[52,245],"health":[53,135,196,246],"centers":[54,247],"within":[55,124],"a":[56,183,220,225,309,324],"district":[57],"Shanghai":[59],"2023":[61],"2025":[63],"were":[64,84,204,248],"used":[65],"primary":[68,281,318],"data":[69],"source.":[70],"Trend":[71],"classification":[72],"and,":[73],"Friedman":[74,222],"nonparametric":[75],"test,":[76,79],"Jonckheere-Terpstra":[77,227],"(JT)":[78],"Kendall's":[81],"W":[82],"test":[83,223],"for":[86,89,114,130,165,191,312,326],"analysis.ResultsThe":[87],"scores":[88,113,129,164,190,208,284],"basic":[91,166],"conditions":[92],"tended":[97],"stabilize,":[99],"while":[100],"dimensions":[101],"such":[102],"talent":[104,172],"cultivation":[105],"improved":[106,180],"year":[107],"by":[108],"year.":[109],"The":[110,126],"fluctuation":[111,127],"practitioners'":[116,214],"disease":[117],"diagnosis":[118,155,215],"treatment":[120,157,217],"capabilities":[121,218],"kept":[123],"19.1%.":[125],"management":[132,193],"common":[134,195],"problems":[136,197],"diagnostic":[138],"standardized":[140,199],"care":[141,282,319],"also":[142],"did":[143],"not":[144],"exceed":[145],"19.3%,":[146],"generally":[149],"consistent":[150,231],"with":[151],"capabilities.":[158],"Longitudinal":[159],"analysis":[160],"revealed":[161],"that":[162],"conditions,":[167],"management,":[171],"training":[173],"discipline":[175],"construction":[176],"continuously,":[181],"whereas":[182,299],"slight":[184],"decline":[185],"observed":[187,205],"care.":[200],"Statistically":[201],"significant":[202,226],"changes":[203],"these":[210],"four":[211],"dimensions.":[212],"General":[213],"showed":[219],"non-significant":[221],"but":[224],"monotonic":[228],"trend,":[229],"indicating":[230],"despite":[233],"fluctuations.":[234],"Based":[235],"on":[236],"slope":[238,265],"total":[240],"score":[241],"changes,":[242],"classified":[249],"into":[250],"improvement-type":[251],"stable-type":[253],"centers;":[254],"distribution":[256],"between":[257],"two":[259],"types":[260],"varied":[261],"according":[262],"threshold":[266],"applied.ConclusionDuring":[267],"three-year":[269],"period":[270],"inspections,":[274],"an":[275],"overall":[276],"upward":[277],"observed.":[286],"Within":[287],"PDSA":[289],"cycle,":[290],"inspection":[292],"execution":[294],"steps":[295],"have":[296],"been":[297],"routinized,":[298],"closed-loop":[300],"feedback":[301],"remains":[302],"be":[304],"strengthened.":[305],"This":[306],"study":[307],"provides":[308],"scientific":[310],"basis":[311],"evaluating":[313],"effectiveness":[315],"interventions":[321],"offers":[323],"reference":[325],"promoting":[327],"high-quality":[329],"sustainable":[331],"development":[332],"system.":[338]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-10-01T00:00:00"}
