Abstract
Objective:To assess the effect of the medical consortium policy on the outcomes of cancer patients admitted to secondary hospitals in Shanxi, China.Method:Electronic medical records of lung cancer (n = 8,193), stomach cancer (n = 5,693) and esophagus cancer (n = 2,802) patients hospitalized in secondary hospitals were used. Propensity score matching was used to match each patient enrolled in medical consortium hospitals with a counterpart admitted in non-medical consortium hospitals. Cox proportional hazard models were used to estimate the hazard ratio of patients enrolled different categories of hospitals.Results:The hazards of lung, stomach and esophageal cancer patients admitted in medical consortium hospitals were consistently and significantly lower than those admitted in non-medical consortium hospitals after adjusting for a number of potential confounders. Lower hazard ratios were associated with lung (hazard ratio (HR) = 0.533, p < 0.001), stomach (HR = 0.494, p < 0.001), and esophagus (HR = 0.505, p < 0.001) cancer patients in medical consortium hospitals.Conclusion:The medical consortium provides an effective strategy to improve the outcomes of cancer patients in Shanxi, China. The partnerships between top-tier hospitals and grassroots medical services bridge the gap in resources and plays a critical role in the quality of care in China.
Highlights
With rapid environmental changes, the global disease spectrum has shifted from an infectious disease model to a chronic non-communicable disease model
Patients in non-medical consortiums had a higher C3 index score and there was a lower percentage of normal status patients upon admission than those in medical consortiums, indicating that severe patients were admitted in non-medical consortium hospitals
The plot indicates that patients enrolled in medical consortiums consistently had higher survival probabilities, compared with those in non-medical consortium hospitals at the same survival time, regardless of types of cancers
Summary
The global disease spectrum has shifted from an infectious disease model to a chronic non-communicable disease model. The Chinese government has been trying to construct various types of vertical integration among tertiary, secondary, and primary care, wishing that this effort could improve medical expertise and skills of personnel in secondary institutions [4,5,6]. At this point, there are three models of vertical integration: loose integration, medical consortium, and direct management [4]
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