Integrated care delivery and health care seeking by chronically-ill patients – a case-control study of rural Henan province, China

International Journal for Equity in Health

Jian Wu³  Shuangbao Xie⁸  Hong Wang⁷  Magnus Lindelow⁹  Jinghua Li¹  Hailun Liang⁵  Nathan Blanchet⁶  Ruth Kidane⁶  De-Chih Lee⁴  Marty Makinen⁶  Leiyu Shi² 

[1] Department of Social Medicine and Health Care Management, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun City, Jilin, China;Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore 21205, Maryland, USA;School of Public Health, Zhengzhou University, Zhengzhou, China;Department of Information Management, Da-Yeh University, Changhua 51591, Taiwan, R.O.C;Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore 21205, Maryland, USA;Results for Development Institute, 1100 15th Street, NW, Washington 20005, DC, USA;Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle 98109, WA, USA;Henan Provincial Health Bureau, Zhengzhou, China;The World Bank, 1225 Connecticut Avenue NW, Washington 20433, DC, USA

关键词: Quality of care;    Integrated care;    Community health centers;    Diabetes;    Primary care;   

Others  :  1235672
DOI  :  10.1186/s12939-015-0221-8

 received in 2015-07-29, accepted in 2015-09-24,  发布年份 2015

【 摘 要 】

Objective

This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China.

Methods

A case-control study was carried out in six health care organizations from two counties in Henan province, China. 371 patients aged 50 years or over with hypertension or diabetes who visited either community health centers or hospitals in the Intervention or Control Counties were systematically selected and surveyed on health care seeking behavior, quality of care, and pathway of care for their major chronic condition. Bivariate analyses were performed to compare quality and value of care indicators between patients from the Intervention and Control Counties. Multivariate analyses were used to confirm these associations after controlling for patients’ demographic and health characteristics.

Results

Patients in both the Intervention and Control Counties chose their current health care providers primarily out of concern for quality of care (provider expertise and adequate medical equipment) and patient-centered care. Compared with the patients from the Control County, those from the Intervention County performed significantly better on almost all the quality and value of care indicators even after controlling for patients’ demographic and health characteristics. Significant associations between types of health care facilities and quality as well as value of care were also observed.

Conclusion

The study showed that the Integrated Care Delivery Model was critical in guiding patients’ health care seeking behavior and associated with improved accessibility, continuity, coordination and comprehensiveness of care, as well as reducing health inequities and mitigating disparities for older patients with chronic conditions.

【 授权许可】

   
2016 Shi et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]National Health and Family Planning Commission of China. China Health and Family Planning Statistical Yearbook 2013. China Union Medical College Press; 2013.
• [2]The world health report 2008: primary health care now more than ever. Switzerland, Geneva; 2008.
• [3]Shi L, Starfield B, Politzer R, Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002; 37(3):529-550.
• [4]Yip WC, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012; 379(9818):833-842.
• [5]McCollum R, Chen L, ChenXiang T, Liu T, Starfield X, Jinhuan B et al.. Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study. Int J Health Plann Manage. 2014; 29(2):e107-126.
• [6]Bhattacharyya O, Delu Y, Wong ST, Bowen C. Evolution of primary care in China 1997-2009. Health Policy. 2011; 100(2-3):174-180.
• [7]Yang H, Shi L, Lebrun LA, Zhou X, Liu J, Wang H. Development of the Chinese primary care assessment tool: data quality and measurement properties. Int J Qual Health Care. 2013; 25(1):92-105.
• [8]National Health and Family Planning Commission of the People's Republic of China. China National Health Yearbook 2013.
• [9]The World Bank “Rural Health Project.” http://www.worldbank.org/en/news/feature/2013/06/06/Hospital-reforms-in-rural-chinaincreased-patient-satisfaction. Accessed March 26, 2015.
• [10]Zhao Y, Hou Z, Wu J, Xie S, Zhang L, Feng Z. Impact on the performance of health workers adopted performance-related contracts in the provision of basic public health service at village and township levels. Iran J Public Health. 2013; 42(4):358-367.
• [11]Aday LA, Andersen R, Fleming GV. Health care in the U.S.: Equitable for whom? Thousand Oaks. Sage Publications, CA; 1980.
• [12]Starfield B. Primary care: balancing health needs, services and technology. Oxford University Press, New York; 1998.
• [13]Tsai J, Shi L, Yu WL, Lebrun LA. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese community. Med Care. 2010; 48:628-34.
• [14]Powell-Jackson T, Yip WC, Han W. Realigning demand and supply side incentives to improve primary health care seeking in rural china. Health Econ. 2014; 24(6):755-772.
• [15]Hung L, Shi L, Wang H, Nie X, Meng Q. Chinese primary care providers and motivating factors on performance. Fam Pract. 2013; 30(5):576-586.
• [16]Rao S, Brammer C, McKethan A, Buntin MB. Health information technology: transforming chronic disease management and care transitions. Prim Care. 2012; 39(2):327-44.
• [17]Tenforde M, Jain A, Hickner J. The value of personal health records for chronic disease management: what do we know? Fam Med. 2011; 43(5):351-4.