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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

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

Authors: Leiyu Shi, Marty Makinen, De-Chih Lee, Ruth Kidane, Nathan Blanchet, Hailun Liang, Jinghua Li, Magnus Lindelow, Hong Wang, Shuangbao Xie, Jian Wu

Published in: International Journal for Equity in Health | Issue 1/2015

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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.
Footnotes
1
The rapid aging of the population and the epidemic of non-communicable diseases call on new chronic care model which includes continuity of care and coordinated services among different providers to address the diverse needs of patients. Since the current health care reform which began in 2009, both Xi and Huaibin County within Henan Province have been actively engaged in reforming public health institutions and policies to improve quality, efficiency and cost control in chronic care delivery. With support from the World Bank-funded Rural Health Project between 2008 and 2014, Xi County was selected as a project area, and targeted intervention was implemented in Xi County to pilot the Integrated Care Delivery Model that aimed to integrate the services among county hospital, township health center and village clinics for patients with chronic conditions.
 
2
Source: Data form Xi and Huaibin Counties.
 
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Metadata
Title
Integrated care delivery and health care seeking by chronically-ill patients – a case-control study of rural Henan province, China
Authors
Leiyu Shi
Marty Makinen
De-Chih Lee
Ruth Kidane
Nathan Blanchet
Hailun Liang
Jinghua Li
Magnus Lindelow
Hong Wang
Shuangbao Xie
Jian Wu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0221-8

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