Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu

Liang, Dan; Lin, Minggui; Chen, Yingyao; Zhou, Ping; Yang, Xiaoguang; Huang, Jiayan

doi:10.5334/ijic.4673

Cited by 16 publications

(25 citation statements)

References 24 publications

(20 reference statements)

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“…21 Under the strong leadership of the district government, comprehensive strategies have been adopted to strengthen primary care and care coordination, improve the quality and efficiency of healthcare delivery, and promote population health. 21 Even so, the treatment rate of hypertension in the elderly population in Shenzhen was still far below that of elderly in other countries such as the USA, Australia, Germany and Colombia. [22][23][24] Similar to other studies, we found that the treatment of hypertension was significantly higher among older, ex-smokers, non-drinkers,higher education level and those engaging in physical activity.…”

Section: Results Of Multivariate Analysis Of Factors Associated With Treatment and Control Of Hypertensionmentioning

confidence: 99%

“…This could be because Shenzhen has established a people-centred integrated care model comprising local community health centres. 21 Under the strong leadership of the district government, comprehensive strategies have been adopted to strengthen primary care and care coordination, improve the quality and efficiency of healthcare delivery, and promote population health. 21 Even so, the treatment rate of hypertension in the elderly population in Shenzhen was still far below that of elderly in other countries such as the USA, Australia, Germany and Colombia.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

Yuan

Zhang

et al. 2021

BMJ Open

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ObjectiveHypertension has become the leading cause of death worldwide. Data on hypertension management among Shenzhen elderly are sparse. Our study aims to investigate treated and controlled hypertension in Shenzhen elderly, and identify relevant predictors.DesignA cross-sectional study.SettingCommunities in Shenzhen, Guangdong, China.ParticipantsA cross-sectional study was conducted. We employed a convenience sampling method to select participants; 124 007 participants aged 65 years and older were recruited from January to December 2018 at local community health centres in Shenzhen.Main outcome measuresData on treatment, control and influencing factors of hypertension were obtained from a standard questionnaire, physical measurements and biochemical analyses.ResultsPrevalence of hypertension was 55.8% among the sample population. Among this group of hypertensive patients, those undergoing hypertension treatment and those with hypertension under control were 54.4% and 32.3%, respectively. Employing multivariate analysis, significant associations were found between treatment and older age, junior high school education and above (OR=1.25, p＜0.05), being widowed rather than being married or cohabiting (OR=1.28, p＜0.05), engaging in physical activity (OR=1.14, p＜0.05), ex-smoker (OR=1.19, p＜0.05), habitual drinker (OR=0.72, p＜0.05), history of cardiovascular disease (CVD) (OR=2.20, p＜0.05) and comorbidities, with a higher probability for those with obesity (OR=1.89, p＜0.05), central obesity (OR=1.10, p＜0.05), diabetes (OR=1.49, p＜0.05) or dyslipidaemia (OR=1.20, p＜0.05). Male sex (OR=0.91, p＜0.05), junior high school education and above (OR=1.28, p＜0.05), engaging in physical activity (OR=1.06, p＜0.05), history of CVD (OR=1.82, p＜0.05) and individuals who had diabetes (OR=1.52, p＜0.05) or dyslipidaemia (OR=1.05, p＜0.05) were associated with increased likelihood of control. Aged 80 years and older (OR=0.93, p＜0.05), habitual drinker (OR=0.73, p＜0.05) and central obesity (OR=0.94, p＜0.05) were negatively associated with control of hypertension.ConclusionsWe found a high prevalence of hypertension, but a low prevalence of treatment and control among Shenzhen elderly.

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Section: Results Of Multivariate Analysis Of Factors Associated With Treatment and Control Of Hypertensionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

Yuan

Zhang

et al. 2021

BMJ Open

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“…Together, it is disappointing for policy makers and implementers to know that there is continuing decreasing choice and willingness of patients choosing PCIs as their firstcontact institutions. However, the tendency is not irreversible given the Chinese government have been informed with the elephant in the room that the grassroot capability has been weakening during the past decade (34,(37)(38)(39). Similar with China, Korean government also faced up with an inefficient use of healthcare resources that about 15% of outpatient visits eligible for primary care happened in high-level hospitals (40).…”

Section: Discussionmentioning

confidence: 99%

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Zhang

Zhong

et al. 2021

Front. Public Health

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Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions.Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression.Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs.Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.

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“…In China, practical examples of integrated care models with SGB-P4P payment methods include Shenzhen Luohu Hospital Group ( 47 , 48 ) and Shanghai Changning District General Practitioner Care Model ( 49 ). In Shenzhen, the Luohu Medical Group implements a health-oriented capitation payment system.…”

Section: Discussionmentioning

confidence: 99%

Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

Liang

Zhang³

et al. 2021

Front. Public Health

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Background: Hypertension has become the second-leading risk factor for death worldwide. However, the fragmented three-level “county–township–village” medical and healthcare system in rural China cannot provide continuous, coordinated, and comprehensive health care for patients with hypertension, as a result of which rural China has a low rate of hypertension control. This study aimed to explore the costs and benefits of an integrated care model using three intervention modes—multidisciplinary teams (MDT), multi-institutional pathway (MIP), and system global budget and performance-based payments (SGB-P4P)—for hypertension management in rural China.Methods: A Markov model with 1-year per cycle was adopted to simulate the lifetime medical costs and quality-adjusted life-years (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 (MDT + MIP + SGB–P4P), and the Usual practice (usual care). We used the incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) to make economic decisions and a 5% discount rate. One-way and probability sensitivity analyses were performed to test model robustness. Data on the blood pressure control rate, transition probability, utility, annual treatment costs, and project costs were from the community intervention trial (CMB-OC) project.Results: Compared with the Usual practice, Option 1 yielded an additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of $3,373.75/QALY, the NMB was –$120.97, and the NHB was −0.076 QALYs. Compared with the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost decreased by $2,007.31, yielding an ICER of –$3,680.72/QALY. The NMB was $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was –$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way sensitivity analysis showed that the most sensitive factors in the model were treatment cost of ESRD, human cost, and discount rate. The probability sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 0.008, 0.813, and 0.179, respectively.Conclusions: The integrated care model with performance-based prepaid payments was the most beneficial intervention, whereas the general integrated care model (MDT + MIP) was not cost-effective. The integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the community management of hypertension in rural China as a continuous, patient-centered care system to improve the efficiency of hypertension management.

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Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu

Cited by 16 publications

References 24 publications

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

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