Association Between Khat (Catha edulis) Consumption and Hepatocellular Enzyme Elevation: A Hospital-Based Case-Control Study.

The rapid, large-scale adoption of OHC platforms represents one of the most significant organizational shifts in modern health service delivery. Precipitated by the COVID-19 global pandemic, this transition towards digital-first models served as a critical strategy for managing escalating patient demands and maintaining healthcare access. This fundamental shift from traditional in-person health service delivery to new digital-first models is driven by both patient demand and the organizational promise of lower-cost, more efficient care, with platforms enabling asynchronous access to doctors. As OHC platforms become increasingly embedded within healthcare systems, the global market for online doctor consultations is expected to reach approximately $35.41 billion USD by 2027. Although the COVID-19 pandemic and subsequent Public Health Emergency (PHE) waivers accelerated the adoption of OHC platforms, often termed telehealth services, healthcare systems now confront a fragmented and uncertain policy landscape. The main debate for providers and health service managers revolves around reimbursement, specifically the sustainability of payment parity for online versus in-person OHC and the looming “telehealth cliff” of expiring private payer waivers. Moreover, health systems must address provider burnout, access disparities driven by the digital divide, and the complexity of state-level licensure laws that inhibit interstate care. To establish a sustainable, equitable, and high-quality digital health infrastructure, there is a pressing need for empirical evidence concerning the key organizational, financial, and regulatory factors influencing service quality from the perspective of healthcare providers. The Chinese healthcare system provides a critical research context for examining the organizational and managerial challenges inherent in this digital transformation. With the emergence of both enterprise-led and, since 2018, hospital-sponsored OHC platforms across China, Internet hospitals have rapidly matured as a viable health service delivery model. For example, the online dermatology consultation service provided by Wuhan First Hospital demonstrates significant diagnostic accuracy alongside improved consultation efficiency. This expansion has been driven by national policies, such as the ‘Internet Diagnosis and Treatment Supervision Rules (Trial)’, which mandate equivalent quality management standards for both online and in-person medical service delivery. Such mandate, which tethers Internet hospitals to physical institutions, creates a practical quality assurance problem for health service managers. Against this background, an examination of OHC service quality, from the perspective of medical staff, is urgently required, given that they are the primary OHC providers responsible for executing this quality mandate. This management mandate is challenging because the nature and evaluation of service quality are fundamentally different in OHC versus in-person consultation services. Traditional service quality dimensions (e.g., the physical environment, admission process, and perceived cost of services) are replaced by process and communication factors dependent on the virtual interaction between patients and doctors.