Abstract
ObjectiveThis study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China.MethodsA case-control study was carried out in six health care organizations from two counties in Henan province, China. 371 patients aged 50 years or over with hypertension or diabetes who visited either community health centers or hospitals in the Intervention or Control Counties were systematically selected and surveyed on health care seeking behavior, quality of care, and pathway of care for their major chronic condition. Bivariate analyses were performed to compare quality and value of care indicators between patients from the Intervention and Control Counties. Multivariate analyses were used to confirm these associations after controlling for patients’ demographic and health characteristics.ResultsPatients in both the Intervention and Control Counties chose their current health care providers primarily out of concern for quality of care (provider expertise and adequate medical equipment) and patient-centered care. Compared with the patients from the Control County, those from the Intervention County performed significantly better on almost all the quality and value of care indicators even after controlling for patients’ demographic and health characteristics. Significant associations between types of health care facilities and quality as well as value of care were also observed.ConclusionThe study showed that the Integrated Care Delivery Model was critical in guiding patients’ health care seeking behavior and associated with improved accessibility, continuity, coordination and comprehensiveness of care, as well as reducing health inequities and mitigating disparities for older patients with chronic conditions.
Highlights
It is a rather common scene in China for patients to be in long lines at large hospitals waiting to make an appointment, while physicians in community health centers (CHCs) are waiting for patients to drop by
Most of the participants in Xi County were covered under the new rural cooperative medical insurance (NRCMI) (88.94 %) but a sizable from Huaibin County were covered under other types of health insurance or uninsured (32.56 %)
The results showed that health care providers in CHCs were more likely to review all the medications (OR: 2. 938; 95 % CI: 1.473, 5.860), coordinate with medication use (OR: 4.092; 95 % CI: 1.785, 9.382), and provide secondary prevention services (OR: 3.577; 95 % CI: 1.858, 6.887)
Summary
It is a rather common scene in China for patients to be in long lines at large hospitals waiting to make an appointment, while physicians in community health centers (CHCs) are waiting for patients to drop by. In a 2008 World Health Report, primary care was promoted as a model for the provision of fair and efficient care [2]. Strong primary care systems were associated with reducing health inequities and mitigating disparities in health care utilization [2, 3]. In China, township health centers (THCs) and rural health stations (RHSs) are the main primary care institutions in rural areas [4]. The outpatient department of county hospitals in rural area provide primary care services [5]. Until now a seamless reciprocal referral system between primary care institutions and hospitals has not been
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