Evaluation of the three-in-one team-based care model on hierarchical diagnosis and treatment patterns among patients with diabetes: a retrospective cohort study using Xiamen's regional electronic health records

Autor: Zhibin Li, Shuyu Yang, Chengming Gu, Changqin Liu, Jing Mei, Jun-Feng Zhang, Zhonghai Sun, Xuejun Li, Xiaoying Li, Yuji Feng
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
China
Hospitals
General
Health informatics
Chronic disease
Health administration
Policy evaluation
03 medical and health sciences
0302 clinical medicine
Health care
medicine
Odds Ratio
Electronic Health Records
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Patient Care Team
business.industry
030503 health policy & services
Health Policy
Nursing research
Public health
lcsh:Public aspects of medicine
Retrospective cohort study
lcsh:RA1-1270
Odds ratio
Community Health Centers
Middle Aged
Patient Acceptance of Health Care
medicine.disease
Health policy reform
Hierarchical health care
Logistic Models
Diabetes Mellitus
Type 2
Female
Medical emergency
0305 other medical science
business
Delivery of Health Care
Cohort study
Research Article
Zdroj: BMC Health Services Research
BMC Health Services Research, Vol 17, Iss 1, Pp 1-11 (2017)
ISSN: 1472-6963
Popis: Background Xiamen is a pilot city in China for hierarchical diagnosis and treatment reform of non-communicable diseases, especially diabetes. Since 2012, Xiamen has implemented a program called the “three-in-one”, a team-based care model for the treatment of diabetes, which involves collaboration between diabetes specialists, general practitioners, and health managers. In addition, the program provides financial incentives to improve care, as greater accessibility to medications through community health care centers (CHCs). The aim of this study was to evaluate the effectiveness of these policies in shifting visits from general hospitals to CHCs for the treatment of type 2 diabetes mellitus (T2DM). Method and materials A retrospective observational cohort study was conducted using Xiamen’s regional electronic health record (EHR) database, which included 90% of all patients registered since 2012. Logistic regression was used to derive the adjusted odds ratio (OR) for patients shifting from general hospitals to CHCs. Among patients treated at hospitals, Kaplan-Meier(KM) curves were constructed to evaluate the time from each policy introduction until the switch to CHCs. A k-means clustering analysis was conducted to identify patterns of patient care-seeking behavior. Results In total, 89,558 patients and 2,373,524 visits were included. In contrast to increased outpatient visits to general hospitals in China overall, the percentage of visits to CHCs in Xiamen increased from 29.7% in 2012 to 66.5% in 2016. The most significant and rapid shift occurred in later periods after full policy implementation. Three clusters of patients were identified with different levels of complications and health care-seeking frequency. All had similar responses to the policies. Conclusions The “three-in-one” team-based care model showed promising results for building a hierarchical health care system in China. These policy reforms effectively increased CHCs utilization among diabetic patients.
Databáze: OpenAIRE
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