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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

Top five reasons of choosing this facility
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Fig2: Top five reasons of choosing this facility

Mentions: FigureĀ 2 displays the top five reasons for choosing the current health care providers reported by patients from the Intervention and Control Counties. The figure depicts the scores on a scale from 1 to 5 with the top reason coded as 5, the next important as 4, and so on. Patients from the two counties had the comparable top three reasons: quality of care (provider expertise), quality of care (adequate medical equipment) and patient-centered care. Patients from the Intervention County reported out-of-pocket cost as their fourth reason for choosing the facility followed by convenience of traveling, while patients from the Control County reported convenience of traveling and insurance plan requirement as their fourth and fifth reasons, respectively. Further analysis showed that while CHC and hospital users shared their top reason: perceived quality of care (competence of providers and staff), they differed on other priorities. CHC users were more likely to care for patient-centered care (responsiveness/respect, privacy, time spent with the doctor, clear explanation of conditions) and convenience (traveling time). However, hospital users were more likely to care for perceived quality of care (equipment and facilities for diagnosis and treatment).Fig. 2


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)

Top five reasons of choosing this facility
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Top five reasons of choosing this facility
Mentions: FigureĀ 2 displays the top five reasons for choosing the current health care providers reported by patients from the Intervention and Control Counties. The figure depicts the scores on a scale from 1 to 5 with the top reason coded as 5, the next important as 4, and so on. Patients from the two counties had the comparable top three reasons: quality of care (provider expertise), quality of care (adequate medical equipment) and patient-centered care. Patients from the Intervention County reported out-of-pocket cost as their fourth reason for choosing the facility followed by convenience of traveling, while patients from the Control County reported convenience of traveling and insurance plan requirement as their fourth and fifth reasons, respectively. Further analysis showed that while CHC and hospital users shared their top reason: perceived quality of care (competence of providers and staff), they differed on other priorities. CHC users were more likely to care for patient-centered care (responsiveness/respect, privacy, time spent with the doctor, clear explanation of conditions) and convenience (traveling time). However, hospital users were more likely to care for perceived quality of care (equipment and facilities for diagnosis and treatment).Fig. 2

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