Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective?

Hu, Hongwei; Liang, Hailun; Wang, Hufeng

doi:10.1016/j.socscimed.2021.114284

Cited by 14 publications

(20 citation statements)

References 15 publications

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“…The selection of covariates was based on previous studies and included patients' and their visiting doctors' characteristics. 21,22 Patients' confounders included age, gender (male vs female), and health insurance status (with vs. without health insurance). FPs' confounders included age, gender (male vs female), marital status (married vs unmarried), education (bachelor's degree and below vs. master's degree and above), professional title (primary title, medium title, and senior title), and working hours per day.…”

Section: Variables Measuredmentioning

confidence: 99%

Family physician services and blood pressure control in China: A population-based retrospective cohort study

Jing

Eggleston

Lai

et al. 2023

J Health Serv Res Policy

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Objective Given the importance of continuous family physician (FP) care in the management of hypertension, we explored the effects of such care among hypertensive patients in China, a country where such care is generally underutilized. We examined the longitudinal association between the use and continuity of FP services and health outcomes including blood pressure (BP) control rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Methods We conducted a population-based cohort study using data from the retrospective regional electronic health record database in Xiamen City, China. The study considered 18,119 hypertensive patients aged over 18 years who had at least two visits to a health center in the preceding 12 months. The generalized estimating equation model was adopted to estimate the longitudinal association between FP service utilization and health outcomes. Results Hypertensive patients treated by their own FPs had a higher BP control rate (OR = 1.14, 95% CI: 1.02–1.28) and lower DBP (−0.36 mmHg, 95% CI: −0.52 to −0.20) than those without a FP or those with a FP but treated by a general community physician (GCP). Compared with hypertensive patients treated exclusively by GCPs, patients treated continuously and exclusively by a FP were 45% more likely to have their BP under control (OR = 1.45, 95% CI: 1.32–1.60), and their SBP and DBP were lower by 0.6 mmHg (95% CI: −0.78 to −0.39) and 0.6 mmHg (95% CI: −0.79 to −0.47), respectively. Conclusions Hypertensive patients continuously treated by their own FPs performed better in terms of BP control rate, SBP and DBP values. In addition, the number and continuity of FP visits were associated with better BP control.

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Section: Variables Measuredmentioning

confidence: 99%

Family physician services and blood pressure control in China: A population-based retrospective cohort study

Jing

Eggleston

Lai

et al. 2023

J Health Serv Res Policy

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“…As displayed in Table 2, the standard deviations of all covariates significantly lowered after PSM was performed, and all the standard deviations were less than 10%. This means that a balance between the widowed and nonwidowed groups has been achieved, and individual differences have been eliminated (Hu et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

Can community‐based care moderate widowhood's health impact? –A longitudinal study among older Chinese adults

Meng

Liu

Xiang

et al. 2022

Health Social Care Comm

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The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short‐term impact of widowhood on the objective health of older adults and to the moderating role of community‐based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM‐DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = −0.154, SE = 0.082) and the number of hospitalisations (B = −1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = −0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

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“…Based on institutional characteristics in China, this approach could not only save costs but also improve the effects of smoking cessation. In recent years, the chronic disease management model of a hospital-community linkage has been applied to the intervention management of many chronic diseases and has achieved good management results (38). However, community health service centers, as the provider of primary healthcare services, have delivered little in terms of services for tobacco control in China.…”

Section: Discussionmentioning

confidence: 99%

A Cost-Effectiveness Analysis of Comprehensive Smoking-Cessation Interventions Based on the Community and Hospital Collaboration

Qin

Jin

et al. 2022

Front. Public Health

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BackgroundThe prevalence of cigarette smoking in China is high and the utilization of smoking cessation clinics is very low. Multicomponent smoking cessation interventions involving community and hospital collaboration have the potential to increase the smoking cessation rate. However, the cost-effectiveness of this intervention model is unknown.MethodsWe conducted a smoking cessation intervention trial in 19 community health service centers in Beijing, China. A cost-effectiveness analysis was performed from a societal perspective to compare three strategies of smoking cessation: no intervention (NI), pharmacological intervention (PI), and comprehensive intervention (CI) (PI plus online health promotion). A Markov model, with a time horizon of 20 years, was used to simulate the natural progression of estimated 10,000 male smokers. A cross-sectional survey was conducted to obtain data on costs and quality-adjusted life years (QALYs) by using the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire. Probabilistic sensitivity analysis was performed to explore parameters of uncertainty in the model.ResultsA total of 680 participants were included in this study, including 283 in the PI group and 397 in the CI group. After 6 months of follow-up, the smoking cessation rate reached 30.0% in the CI group and 21.2% in the PI group. Using the Markov model, compared with the NI group, the intervention strategies of the PI group and the CI group were found to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of $535.62/QALY and $366.19/QALY, respectively. The probabilistic sensitivity analysis indicated that the CI strategy was always the most cost-effective intervention.ConclusionCI for smoking cessation, based in hospital and community in China, is more cost-effective than PI alone. Therefore, this smoking cessation model should be considered to be implemented in healthcare settings.

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Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective?

Cited by 14 publications

References 15 publications

Family physician services and blood pressure control in China: A population-based retrospective cohort study

Family physician services and blood pressure control in China: A population-based retrospective cohort study

Can community‐based care moderate widowhood's health impact? –A longitudinal study among older Chinese adults

A Cost-Effectiveness Analysis of Comprehensive Smoking-Cessation Interventions Based on the Community and Hospital Collaboration

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