Enhancing radiology capacity in primary care via tertiary-hospital trusteeship: 5-year evaluation in an integrated health system.

BACKGROUND

This study evaluates the feasibility and effectiveness of a tertiary hospital-led trusteeship model in strengthening radiology capacity within primary healthcare institutions under a high-level integrated healthcare system.

METHODS

From 2018 to 2022, Zhejiang Hospital implemented a radiology department trusteeship model at Xihu District Hospital, comprising three core components: (1) deployment of expert resources through on-site and remote reporting, (2) full-process quality control, and (3) targeted personnel training. Clinical satisfaction was assessed via structured electronic questionnaires administered before (2016-2017) and after (2018-2022) implementation among frontline clinicians from internal medicine, surgery, orthopedics, and general wards. The survey utilized a 5-point Likert scale across five domains. Quantitative trends in Digital Radiography (DR) and Computed Tomography (CT) workload, as well as remote consultation volumes, were analyzed. Additionally, blinded quality assessments were conducted on 100 randomly selected radiology reports (50 DR and 50 CT, equally divided pre- and post-intervention) using a standardized 100-point scoring system. Statistical analyses were performed using SPSS 22.0.

RESULTS

A total of 28 clinicians participated (male: 9, female: 19; median age: 40 years). Post-intervention, significant improvements were observed in timeliness (median [interquartile range, IQR]: 4.5 [4, 5] → 5 [5, 5], P = 0.006), diagnostic quality (4 [4, 5] → 5 [5, 5], P = 0.007), and clinical guidance (4 [4, 5] → 5 [5, 5], P = 0.003). No significant changes were noted in willingness to participate in case discussions or referral intentions. Clinical practicality was identified as the highest priority for improvement (46.4%). Notable structural shifts in imaging utilization were observed: DR examinations declined from 14,224 (2017) to 7,209 (2022), while CT examinations increased from 0 to 8,415 over the same period. Remote consultation volume rose from 342 (2018) to 507 (2022). Radiology report quality scores improved significantly (61 [57,63] → 85 [83,87], P < 0.001). Over 96% of respondents expressed support for the continued implementation of the model.

CONCLUSIONS

The "West Lake Model" trusteeship effectively addressed primary care radiology challenges, enhancing service capacity and clinical utility. It provides a scalable framework for improving integration within tiered healthcare systems.

CLINICAL TRIAL NUMBER: Not applicable.