Clinical research in non-university public hospitals correlated with improved patient outcomes

More than 10 percent of full-time clinicians in Hong Kong’s non-university public hospitals engaged in original research as principal investigators (PIs), contributing to nearly one-third of the city’s peer-reviewed studies published in 2016–2021. Their clinical research activity is correlated with improved patient outcomes.

In a territory-wide retrospective observational study, researchers from Kwong Wah Hospital, Prince of Wales Hospital, and the Chinese University of Hong Kong analyzed peer-reviewed original clinical research conducted by medical staff at public general acute hospitals, in which the staff member served as a PI. The analysis included articles published between January 2016 and April 2021, retrieved from the MEDLINE database. [Hong Kong Med J 2025;doi:10.12809/hkmj2311155]

HK’s public clinicians active in research

During the 5.5-year study period, 3,142 peer-reviewed original clinical research articles were published by researchers from Hong Kong’s public acute hospitals. Nearly one-third (29.3 percent; n=921) of these studies were from non-university hospitals. Approximately half of the research articles from non-university hospitals were case reports or technical notes.

A majority (96.3 percent) of the non-university PIs were clinicians. These clinician-researchers comprised 10.8 percent of the full-time clinician workforce of non-university public hospitals during the study period. According to the study’s authors, this level of participation in original clinical research despite the heavy frontline workload was encouraging.

Which specialties were most productive?

After controlling for workforce discrepancies between disciplines, clinical oncology was the most productive specialty in terms of the mean number of articles published per clinician (0.565), followed by orthopaedics and traumatology (0.525), and obstetrics and gynaecology (O&G; 0.506).

O&G was the most research-active specialty, with 32.1 percent of clinicians participating as PIs.

Research quality

The overall mean journal impact factor of research articles from non-university public hospitals was 2.34 ± 3.72, while the Eigenfactor score was 0.01 ± 0.07. At the article level, the mean total number of citations (TNC) was 6.33 ± 24.17, mean Field Citation Ratio (FCR) was 3.37 ± 2.04, and mean Relative Citation Ratio (RCR) was 0.82 ± 3.32.

“The quality of the research undertaken was encouraging,” the authors noted. “All medical specialties achieved an FCR >1.00, indicating higher article citation rates than counterparts in the same research field.”

Oncology research had a significantly higher mean FCR (5.82 ± 2.41) than research in other disciplines (p<0.001).

Clinical research correlated with improved outcomes

Significant negative correlations were observed between crude mortality rate and RCR (r=-0.63; p=0.022), and between 30-day unplanned readmissions and RCR (r=-0.72; p=0.006).

However, no significant correlations were observed between inpatient length of stay (LOS) and TNC (r=-0.32; p=0.29), or between LOS and RCR (r=-0.36; p=0.23).

A call for supportive infrastructure and funding

“Establishment of research-supportive infrastructure and dedicated funding for non-university public hospitals may contribute to improved patient outcomes,” the authors noted, highlighting that most funding agencies favour research led by academic clinicians over community clinicians.

Suggested supportive measures include policies for protected time or career incentives for research, a primary review authority for investigative drug registration to streamline regulatory pathways, a clinical research institute or academy to support early-career clinician-scientists, and publicly funded administrative services to accelerate translational research.