Inpatient non-communicable disease patterns and influencing factors at two tertiary hospitals in New Zealand and China: a mixed-methods study protocol

Non-communicable diseases (NCDs), including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, represent a growing inpatient burden worldwide. Yet hospital-based cross-national mixed-methods comparisons remain scarce, and the factors shaping inpatient NCD care are poorly understood. This protocol describes an explanatory sequential mixed-methods study examining inpatient NCD characteristics, disease patterns and hospitalisation indicators in tertiary hospitals in New Zealand and China, and exploring multilevel influences on NCD care. Guided by the Social Ecological Model, the study will be conducted at Waikato Hospital and the Third People's Hospital of Yibin. In the quantitative phase, de-identified discharge records of adult inpatients aged ≥ 16 years with a primary diagnosis of one of the major NCDs will be extracted for 2023-2025. Analyses will be stratified by NCD category, and multivariable regression models with site as a fixed effect will examine variations in hospitalisation outcomes. In the qualitative phase, semi-structured interviews will be conducted with approximately 30-40 healthcare professionals across both settings. Interview data will be analysed thematically and integrated with quantitative findings using joint displays. To our knowledge, this is the first mixed-methods comparison of inpatient NCD care between tertiary hospitals in China and New Zealand. Findings are expected to support cross-cultural learning and inform evidence-based strategies to improve inpatient NCD management across diverse healthcare systems. This protocol is reported in accordance with the GRAMMS, STROBE and COREQ guidelines.