Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China – a study protocol

Abstract

BackgroundChronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care.MethodsAn educational intervention was conducted in three pilot counties in Jiangsu province, a high-income province in southeast China. The intervention was based on the model of vertical integrated care between the three-levels of healthcare institutions. In the pilot counties, 22 townships were included (11 in the intervention and control groups, respectively). Service teams assembled by the local health bureaus implemented the intervention which provides services for both patients and healthcare professionals. Questionnaire interviews (n = 4259) and medical records were used to collect patient data (physiological measures, health-related quality of life, satisfaction with care). Data from healthcare professionals (n = 282) was gathered through questionnaires and in-depth interviews (knowledge about chronic diseases, general procedure of diagnosing and registering, chronic disease management situation, perceptions of chronic disease treatment and prevention). Baseline data were collected before the start of the intervention in Nov 2015, follow-up data in Oct-Nov 2016, and final data completed in Jul-Aug 2017.DiscussionThe intervention has been conducted smoothly and gotten support from patients, healthcare institutions and local health authorities. The research team anticipates that the vertical integrated model will improve patients’ health, satisfaction with care, and their understanding of their chronic disease. We also anticipate that healthcare professionals can acquire more information about chronic diseases and improve their strategy for providing good quality care for patients.Trial registrationISRCTN13319989 Registration date: 4th April, 2017.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3355-8) contains supplementary material, which is available to authorized users.

Job burnout and correlated factors of three‐tiered public health workers: A cross‐sectional study in China

“…By contrast, residents mainly ignore the status of public health workers, hence leading to the high LPA of the latter. Moreover, existing studies indicate that public health works, such as management of chronic diseases, in China is still highly dependent on hospital doctors rather than on public health workers (Chen, Burström, Sparring, & Qian, ). Health system integration tends to focus on medical institutions, whereas public health institutions are often placed on the edge of integration (Martin et al, ).…”

Differential Impact of an Education-Based Intervention for Patients with Type 2 Diabetes Mellitus in Rural China

“…This study is nested within a research project on vertical integration strategies in health services for rural patients with chronic diseases (Studying the Vertical Integration Strategy of Chronic Disease Service Based on Multiple Incentive Mechanisms in Rural China, ISRCTN13319989) [16], which focuses on optimizing the care of patients with type 2 diabetes mellitus and primary hypertension in three pilot counties in rural areas of Jiangsu province. An education-based intervention directed to healthcare professionals and patients was performed to shift the care of patients with type 2 diabetes mellitus and primary hypertension from the hospital to primary care services and to improve vertical integration in healthcare for patients with these conditions.…”

“…Patients in the control areas received routine services as usual. The intervention is explained more in detail in the study protocol [16]. This study followed the Consolidated Standards of Reporting Trials (CONSORT) Guidelines (Supplemental file).…”

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

“…The study is part of a research project on vertical integration strategies in health services for rural patients with chronic diseases ("Studying the Vertical Integration Strategy of Chronic Disease Service Based on Multiple Incentive Mechanism in Rural China", ISRCTN13319989) [25], which focuses on optimizing the care of patients with chronic disease in three pilot counties in rural areas of Jiangsu province, through improved collaboration between the county-level hospital and PHC. Patients with T2DM and primary hypertension and health care professionals in PHC in rural areas received an educational intervention to shift the care from hospital to PHC services and to improve the vertical integration in health care for patients with these conditions [25]. The present study focuses on health care professionals and concentrates on T2DM.…”