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Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

Shi L, Lee DC, Liang H, Zhang L, Makinen M, Blanchet N, Kidane R, Lindelow M, Wang H, Wu S - Int J Equity Health (2015)

Bottom Line: Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators.Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics.The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. lshi@jhsph.edu.

ABSTRACT

Objective: Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness.

Methods: The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics.

Results: Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers.

Conclusion: The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

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Related in: MedlinePlus

Top Five Reasons of Choosing This Facility
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Fig1: Top Five Reasons of Choosing This Facility

Mentions: Figure 1 shows the top five reasons for choosing the current health providers reported by patients from the three cities. The respondents chose the top five reasons from 15 options presented in the questionnaire. The figure depicts the scores on a scale from 1 to 5 with the top reason coded as 5, the next important reason coded 4, and so on. Patients from Shenzhen and Guangzhou had comparable top five reasons despite slight difference in ranking. These were convenience (traveling), quality of care (providers), patient-centered care, quality of care (equipment), and insurance plan requirement. Patients from Shenzhen reported traveling time as their top reason for choosing this facility for care, whereas patients from Guangzhou reported quality of care (provider) as their top reason. For Dongguan, patients shared four of the five reasons as those reported by patients from Shenzhen and Guangzhou. Instead of traveling time, they identified out-of-pocket cost as one of their top five reasons.Fig. 1


Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

Shi L, Lee DC, Liang H, Zhang L, Makinen M, Blanchet N, Kidane R, Lindelow M, Wang H, Wu S - Int J Equity Health (2015)

Top Five Reasons of Choosing This Facility
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4663727&req=5

Fig1: Top Five Reasons of Choosing This Facility
Mentions: Figure 1 shows the top five reasons for choosing the current health providers reported by patients from the three cities. The respondents chose the top five reasons from 15 options presented in the questionnaire. The figure depicts the scores on a scale from 1 to 5 with the top reason coded as 5, the next important reason coded 4, and so on. Patients from Shenzhen and Guangzhou had comparable top five reasons despite slight difference in ranking. These were convenience (traveling), quality of care (providers), patient-centered care, quality of care (equipment), and insurance plan requirement. Patients from Shenzhen reported traveling time as their top reason for choosing this facility for care, whereas patients from Guangzhou reported quality of care (provider) as their top reason. For Dongguan, patients shared four of the five reasons as those reported by patients from Shenzhen and Guangzhou. Instead of traveling time, they identified out-of-pocket cost as one of their top five reasons.Fig. 1

Bottom Line: Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators.Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics.The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. lshi@jhsph.edu.

ABSTRACT

Objective: Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness.

Methods: The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics.

Results: Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers.

Conclusion: The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

Show MeSH
Related in: MedlinePlus