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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

Patient Satisfaction to Current Care Provider (1–5 Likert Scale)
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Fig2: Patient Satisfaction to Current Care Provider (1–5 Likert Scale)

Mentions: The relationship between models of primary care delivery and patient satisfaction with the current care provider is displayed in Fig. 2. The question is worded as follows in the questionnaire: How satisfied are you with the following aspects of the care experience you got most recently from this provider (1–5 Likert scale)? The figure visualizes the satisfaction scores of 13 indicators reported by patients from the three cities on a scale from 1 to 5 with 1 indicating least satisfied and 5 most satisfied. From the results of ANOVA analysis, patients from Dongguan reported significantly higher scores in nine of the 13 indicators (all the measures were above 4.00), greater than those from Shenzhen and Guangzhou. The most notable differences were between subjects from Dongguan and Guangzhou in service comprehensiveness (4.40 vs. 4.03, p < 0.001), out-of-pocket cost (4.36 vs. 3.84, p < 0.001), and out-of-office hours (4.31 vs. 3.79, p < 0.001).Fig. 2


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)

Patient Satisfaction to Current Care Provider (1–5 Likert Scale)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Patient Satisfaction to Current Care Provider (1–5 Likert Scale)
Mentions: The relationship between models of primary care delivery and patient satisfaction with the current care provider is displayed in Fig. 2. The question is worded as follows in the questionnaire: How satisfied are you with the following aspects of the care experience you got most recently from this provider (1–5 Likert scale)? The figure visualizes the satisfaction scores of 13 indicators reported by patients from the three cities on a scale from 1 to 5 with 1 indicating least satisfied and 5 most satisfied. From the results of ANOVA analysis, patients from Dongguan reported significantly higher scores in nine of the 13 indicators (all the measures were above 4.00), greater than those from Shenzhen and Guangzhou. The most notable differences were between subjects from Dongguan and Guangzhou in service comprehensiveness (4.40 vs. 4.03, p < 0.001), out-of-pocket cost (4.36 vs. 3.84, p < 0.001), and out-of-office hours (4.31 vs. 3.79, p < 0.001).Fig. 2

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