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Integrated care delivery and health care seeking by chronically-ill patients - a case-control study of rural Henan province, China.

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

Bottom Line: Patients 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.

View Article: PubMed Central - PubMed

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

ABSTRACT

Objective: This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China.

Methods: A 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.

Results: Patients 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.

Conclusion: The 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.

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Related in: MedlinePlus

The integrated care delivery model for hypertension
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Fig1: The integrated care delivery model for hypertension

Mentions: For example, in Henan Province, the most populous and the largest agricultural province in China, with support from World Bank’s Rural Health Project [9], the government instituted an Integrated Care Delivery Model to promote appropriate health care utilization by improving access and coordination through the adoption of computerized clinical pathways, a shift from fee-for-service to case-based payment, performance-based payment for care providers, and Information technology (IT) -based monitoring on service quality of health care facilities. The overarching framework is a vertical referral system among different types of medical institutions. The system is designed to guide patients to appropriate medical institutions based on severity of diseases. Specifically, the hospitals would treat more complicated cases and township health centers and rural health stations (hereafter referred to as CHCs for simplicity) focus on primary care and chronic disease management. For patients, treatment would start from CHCs. The patients would then be referred either upwards to county hospitals or downwards to village clinics on the basis of severity of disease within a vertical system. As illustration, Fig. 1 depicts an Integrated Care Delivery Model for hypertensive patients across this primary care network. Another important intervention is a global payment system whereby CHCs as well as hospitals are paid based on patients’ clinical diagnoses and adherence to clinical pathways. The new model does not make it mandatory for patients to obtain care at a CHC first, but patients will pay significantly less copayment if seeking care from CHCs first. Patients referred by CHCs also get a significant discount in addition to receiving expedited treatment at county hospitals. Finally, the intervention includes an integrated information system, by which CHCs and hospitals share patients’ information. Table 1 compares the differences in the models of care between the Intervention and Control Counties.Fig. 1


Integrated care delivery and health care seeking by chronically-ill patients - a case-control study of rural Henan province, China.

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

The integrated care delivery model for hypertension
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4663729&req=5

Fig1: The integrated care delivery model for hypertension
Mentions: For example, in Henan Province, the most populous and the largest agricultural province in China, with support from World Bank’s Rural Health Project [9], the government instituted an Integrated Care Delivery Model to promote appropriate health care utilization by improving access and coordination through the adoption of computerized clinical pathways, a shift from fee-for-service to case-based payment, performance-based payment for care providers, and Information technology (IT) -based monitoring on service quality of health care facilities. The overarching framework is a vertical referral system among different types of medical institutions. The system is designed to guide patients to appropriate medical institutions based on severity of diseases. Specifically, the hospitals would treat more complicated cases and township health centers and rural health stations (hereafter referred to as CHCs for simplicity) focus on primary care and chronic disease management. For patients, treatment would start from CHCs. The patients would then be referred either upwards to county hospitals or downwards to village clinics on the basis of severity of disease within a vertical system. As illustration, Fig. 1 depicts an Integrated Care Delivery Model for hypertensive patients across this primary care network. Another important intervention is a global payment system whereby CHCs as well as hospitals are paid based on patients’ clinical diagnoses and adherence to clinical pathways. The new model does not make it mandatory for patients to obtain care at a CHC first, but patients will pay significantly less copayment if seeking care from CHCs first. Patients referred by CHCs also get a significant discount in addition to receiving expedited treatment at county hospitals. Finally, the intervention includes an integrated information system, by which CHCs and hospitals share patients’ information. Table 1 compares the differences in the models of care between the Intervention and Control Counties.Fig. 1

Bottom Line: Patients 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.

View Article: PubMed Central - PubMed

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

ABSTRACT

Objective: This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China.

Methods: A 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.

Results: Patients 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.

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus