In a multicenter cross-sectional study examining vascular access services across 57 secondary and tertiary general hospitals in Guizhou Province, China, researchers found that hospital grade was most strongly associated with peripherally inserted central catheter (PICC) placement operational status. Although centralized catheterization units represented the most common organizational approach across the surveyed healthcare institutions, advanced multilevel statistical modeling revealed that the chosen placement mode had no independent association with overall operational performance once institutional clustering across hospitals was accounted for.

Published in BMC Health Services Research by lead investigator Yansheng Peng alongside co-authors Ruijuan Liu, Liping Liao, Wenyu Huang, and Yuan Li, the investigation was designed to address a critical gap in regional healthcare delivery. Prior to this survey, the distribution of PICC placement modes across different institutional hospital grades in Guizhou Province, as well as the institutional and provider-level factors influencing their operational status, had remained largely unclear. To systematically examine these characteristics, the research team evaluated service operations using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analytical framework, aiming to identify the key determinants associated with composite SWOT evaluation scores.

To gather operational data across diverse clinical settings, the investigators administered a de-novo web-based questionnaire specifically developed for qualified vascular access personnel. Psychometric assessment confirmed that the measurement instrument possessed high reliability and structural validity, demonstrating an overall Cronbach’s alpha coefficient of 0.950 and a Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy of 0.937. The multicenter recruitment strategy successfully enrolled a total of 278 qualified PICC placement nurses working within 57 secondary and tertiary general hospitals across Guizhou Province.

Institutional-level analysis revealed that the centralized placement mode was the predominant operational model across the region, accounting for 54.4 percent of the participating facilities (31 of the 57 surveyed hospitals). In comparison, the decentralized placement mode and the mixed placement mode each accounted for 22.8 percent of the institutional sample, representing 13 hospitals apiece. At the clinician level, nursing participation reflected a similar structural distribution across the three organizational models: among the 278 surveyed nurses, 41.4 percent practiced catheter placement within the centralized mode, 25.5 percent delivered care within the decentralized mode, and 33.1 percent carried out placement responsibilities under the mixed mode.

The distribution of these PICC placement configurations exhibited a highly significant statistical association with hospital grade across the province (chi-square = 52.747, P < 0.001). Tertiary Grade A hospitals primarily used decentralized and mixed placement modes. In contrast, other tertiary hospitals and secondary Grade A hospitals primarily adopted the centralized placement mode.

To evaluate differences in operational status across clinical settings while appropriately managing the nested nature of workforce data, the research team conducted statistical analyses utilizing the Kruskal–Wallis H test in combination with two-level random-intercept linear mixed-effects models. This hierarchical modeling revealed substantial clustering among nurses practicing within the same hospital facilities, demonstrating an intraclass correlation coefficient (ICC) of 0.394. Hospital grade emerged as the single factor most strongly associated with the overall SWOT score, with composite operational scores demonstrating a statistically significant, stepwise decrease moving from tertiary Grade A hospitals down through other tertiary hospitals to secondary Grade A hospitals (all P < 0.01).

At the individual practitioner level, clinician procedural experience also showed a significant relationship with operational evaluation scores. Nurses with an annual personal placement volume of 101 to 500 catheterizations achieved significantly higher overall SWOT scores compared with the baseline reference group of nurses performing 50 or fewer procedures annually (P < 0.001). However, after accounting for hospital-level clustering, placement mode showed no independent association with the overall SWOT score (P > 0.05).

Synthesizing their findings, Peng and colleagues concluded that the operational status and real-world performance of any given PICC placement mode are primarily associated with the underlying resource endowment, staffing capacity, and structural support of the parent hospital rather than the chosen delivery model itself. Consequently, the authors caution healthcare administrators against prioritizing or mandating a single standardized placement mode across all institutional tiers. To effectively enhance regional PICC services, the researchers recommend directing increased resource investments toward secondary and non-Grade-A tertiary hospitals while formulating tailored operational strategies matched to each hospital grade’s unique clinical environment.

Subject of Research: Operational status and factors influencing PICC placement modes across hospital grades in Guizhou Province

Article Title: SWOT analysis of PICC placement modes in hospitals of different grades in Guizhou Province: a multicenter survey study

Article References: Peng, Y., Liu, R., Liao, L., Huang, W., & Li, Y. (2026). SWOT analysis of PICC placement modes in hospitals of different grades in Guizhou Province: a multicenter survey study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-16142-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-16142-1

Keywords: peripherally inserted central catheter, PICC placement modes, centralized placement mode, decentralized placement mode, mixed placement mode, SWOT framework, hospital grade, tertiary Grade A hospitals, secondary Grade A hospitals, multilevel linear mixed-effects model, Guizhou Province, multicenter cross-sectional study, nurse placement volume, intraclass correlation coefficient, health services research, vascular access nursing