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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Effects of integrated chronic care models on hypertension outcomes and spending: a multi-town clustered randomized trial in China

Authors: Yuting Zhang, Wenxi Tang, Yan Zhang, Lulu Liu, Liang Zhang

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Hypertension affects one billion people globally and is one of the leading risk factors for cardiovascular and renal diseases. However, hypertension management remains poor, especially in rural China.

Methods

A clustered randomized controlled trial was conducted in six towns in China’s Qianjiang county between 7/2012 and 6/2014, including 5462 hypertension patients above 35 years old. Six towns were randomly assigned to three groups: Group 1 had the integrated care model including a multidisciplinary team and continuous care coordination, Group 2 had both the integrated care model and provider-level financial incentives, and the control group had the usual care. Primary outcomes were systolic blood pressure and health-related quality of life measured by SF36; secondary outcomes included hypertension-related hospitalization rate and inpatient spending. Blood pressure was measured sixteen times bimonthly between 12/1/2011 and 6/30/2014, and quality of life was measured on 7/1/2012 and 6/30/2014. Inpatient data between 7/1/2010 and 8/31/2014 were used. This trial is registered at the World Health Organization’s International Clinical Trials Registry, number ChiCTR-OOR-14005563.

Results

We found that the integrated care model effectively lowered blood pressure by 1.93 mmHg (95% CI 0.063–3.8), improved self-assessed health-related quality of life, and reduced the rate of hypertension-related hospitalization by 0.17 percentage points (95% CI 0.094–0.24). We also found that the provider-level financial contract further lowered blood pressure by 1.76 mmHg (95% CI 0.73–2.79) and reduced rates of hospitalization and inpatient spending, but it also reduced patients’ self-assessed health-related quality of life.

Conclusions

Integrated care and financial incentives are effective in lowering blood pressure and reducing hospitalization rate, but financial contracts may hurt patient quality of life.
This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563) on November 23, 2014. It was a retrospective registration.
Appendix
Available only for authorised users
Footnotes
1
During the intervention period, the operations of the social health insurance in Qianjiang were reorganized from county level to city level and the Qianjiang county health bureau no longer had authority to change the reimbursement policy. As a result, although the contract stated a bonus to be 60% of the savings, the actual bonus at the end of the project was set by the head of the Qianjiang administrative office as CNY70K (USD10,654) per town in Group 2, and it was actually paid through the research grant to be shared among 23 clinicians and four non-clinical staff. However, during the intervention period, providers were not aware of this change, so they were still subject to the incentives in the contracts.
 
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Metadata
Title
Effects of integrated chronic care models on hypertension outcomes and spending: a multi-town clustered randomized trial in China
Authors
Yuting Zhang
Wenxi Tang
Yan Zhang
Lulu Liu
Liang Zhang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4141-y

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