Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database

Sun, Minmin; Rasooly, Alon; Fan, Xiaoqi; Jian, Weiyan

doi:10.1136/bmjopen-2019-035192

Cited by 12 publications

(11 citation statements)

References 44 publications

(37 reference statements)

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“…This may be one of the causes for the suboptimal performance in key indicators (e.g., retinopathy, foot, peripheral neuropathy monitoring). Health counseling indicators in our study, such as diet counseling (79.5%) and exercise counseling (76.9%) were performed better than another national survey in China (diet 65.0%, exercise 49.0%) [ 11 ], the main reason might be that the general practice in CHSC in Beijing were better developed and can provide relatively high-quality services, compared with other regions in China [ 35 ]. There was still room for improvement, especially in medication safety (48.3%) and emergency help counseling (42.5%).…”

Section: Discussionmentioning

confidence: 71%

“…And among patients treated, 49.4% had glycosylated hemoglobin (HbA1c) controlled [ 10 ]. Another national study reported that during 2011–2015, the recurrent hospital admission rate among people with diabetes steeply increased from 18.87% to 28.45% [ 11 ]. Health information technology systems for diabetes care are essential for continuity and coordination [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China

et al. 2022

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Background Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care. Methods Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality. Results The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values < 0.05). Regular follow up (p = 0.039), plasma blood glucose (p = 0.020), blood pressure (p = 0.026), body mass index (p = 0.044) and foot (p = 0.005) monitoring as well as each of the 6 health counseling indicators (all the p values < 0.05) were more likely to be received by patients when continuity of care was ensured. Patients who were managed by a GP team had higher utilization rate of glycosylated hemoglobin monitoring (p = 0.026) and each of the 6 health counseling indicators (all the p values < 0.05). When the patients perceived one more FDS attribute, the indicators they received significantly increased by 1.50 (coefficient = 1.50, p < 0.001). Patients between the age of 65 and 74 years received 1.15 more indicators than those under 65 (coefficient = 1.15, p = 0.003). Patients with more than ten years duration of T2DM received 0.74 more indicators (coefficient = 0.74, p = 0.028). Patients taking both insulin and oral medicine received 0.97 more indicators than those taking oral medication only (coefficient = 0.97, p = 0.027). Patients who were managed by GPs with on-job training experience received 1.19 more indicators (coefficient = 1.19, p = 0.040). Among the patients who had completed junior high school or below, having better self-report health status (≥ 60) received 2.40 less indicators (coefficient = -2.40, p = 0.004). Conclusions Improvement of key monitoring and health counseling indicators might be needed in T2DM care in general practice in Beijing, China. Policies for improving process quality of T2DM care should be considered.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China

et al. 2022

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“…In the past ten years of health care reform, China has been working hard to improve the primary health care system, and the government has included diabetes in the national basic public health service projects, including self-management education ( 27 ). However, between 2011 and 2015, the rates of patients with diabetes who received health education showed a decreasing trend ( 28 ). Generally, the quality characteristics of primary health care in China were poor.…”

Section: Discussionmentioning

confidence: 99%

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China

Cao

et al. 2021

Front. Endocrinol.

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BackgroundThe number of type 2 diabetes mellitus (T2DM) cases among empty-nest elderly increases with increasing aging in China. Self-care plays an important role in preventing and reducing adverse outcomes of diabetes; however, few studies focus on self-care experiences of empty-nest elderly with T2DM.ObjectiveTo explore self-care experiences for a chronic disease among empty-nest elderly patients with T2DM in mainland China.MethodsA descriptive phenomenological design was used in this study. Semi-structured interviews were conducted for 15 empty-nesters with T2DM. Interviews were implemented in department of endocrinology at a tertiary teaching hospital located in Shandong province, east of China.ResultsThe participants were poorly adept with monitoring their blood glucose and lacked the ability to deal with abnormal blood glucose levels. Most participants had a good relationship with medication and physical activity. Living without children was perceived as a benefit that improved dietary management and is a disadvantage in terms of economic and emotional support and access to medical resources. Elderly empty-nesters also lacked knowledge about diabetes and paid little attention to potential complications.ConclusionEmpty-nest elderly patients with T2DM value medication compliance and lifestyle modification more than blood glucose monitoring, complication prevention, and coping with negative emotions. Friends and spouses play indispensable roles in patients’ self-care motivation and maintenance. Diabetes education on self-care, access to medical resources, and social support is needed for better diabetes management.

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“… 9 Furthermore, a nationally representative study of the quality of PHC for diabetes in China showed that diabetes-related hospitalizations have increased from about 4% in 2011 to 6% in 2013, while recurrent hospitalizations among individuals with diabetes increased from almost 19% in 2011 to 28% in 2015. 11 As hospitalizations serve as a proxy outcome indicator for the quality of primary diabetes care, these findings highlight the urgent need to improve the level of care delivered by primary care practitioners in China.…”

Section: Introductionmentioning

confidence: 97%

Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China

Rasooly

Pan

Tang

et al. 2022

Int J Health Policy Manag

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Background: Quality measurements in primary healthcare have become an essential component for improving diabetes outcomes in many high-income countries. However, little is known about their implementation within the Chinese health-system context and how they are perceived by patients, physicians, and policy makers. We examined stakeholders’ perceptions of quality and performance measurements for primary diabetes care in Shanghai, China, and analyzed facilitators and barriers to implementation. Methods: In-depth interviews with 26 key stakeholders were conducted from 2018 to 2019. Participants were sampled from two hospitals, four community healthcare centers (CHCs), and four institutes involved in regulating CHCs. The Consolidated Framework for Implementation Research (CFIR) guided data analysis. Results: Existing quality measurements were uniformly implemented via a top-down process, with daily monitoring of family doctors’ work and pay-for-performance incentives. Barriers included excluding frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback. Findings under the CFIR construct "organizational incentives" suggested that current pay-for-performance incentives function as a "double-edged sword", increasing family doctors’ motivation to excel while creating pressures to "game the system" among some physicians. When considering the CFIR construct "reflecting and evaluating", policy makers perceived the online evaluation application – which provides daily reports on family doctors’ work – to be an essential tool for improving quality; however, this information was not visible to patients. Findings included under the "network and communication" construct showed that specialists support the work of family doctors by providing training and patient consultations in CHCs. Conclusion: The quality of healthcare could be considerably enhanced by involving patients and physicians in decisions on quality measurement. Strengthening hospital–community partnerships can improve the quality of primary care in hospital-centric systems. The case of Shanghai provides compelling policy lessons for other health systems faced with the challenge of improving primary healthcare.

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Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database

Cited by 12 publications

References 44 publications

Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China

Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China

Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China

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