Journal Article

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

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

2017

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Biostatistics / Blood Pressure / Cardiovascular diseases / Care and treatment / China / Chronic illnesses / Clinical outcomes / Clinical research / Clinical trials / Clinics / Cluster Analysis / Clustered randomized trial / Continuity of care / Control methods / Coordination / Cost of Illness / Delivery of Health Care, Integrated - economics / Delivery of Health Care, Integrated - methods / Environmental Health / Epidemiology / Expenditures / Female / Financial incentives / Funding / Groups / Health Care Costs - statistics & numerical data / Health care expenditures / Health care policy / Health insurance / Health policies / Health promotion / Health risks / Health services / Health status / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Humans / Hypertension / Hypertension - economics / Hypertension - therapy / Incentives / Inpatient care / Integrated care / Integrated chronic care model / Interdisciplinary aspects / Intervention / Kidney transplantation / Long-Term Care - economics / Long-Term Care - methods / Male / Medical care quality / Medicine / Medicine & Public Health / Middle Aged / Monetary incentives / Multidisciplinary teams / Patients / Preventive medicine / Primary care / Public Health / Quality assessment / Quality of care / Quality of Life / Registration / Research Article / Risk analysis / Risk factors / Rural areas / Rural poverty / Self evaluation / Studies / systems and management in low and middle-income countries / Towns / Treatment Outcome / Vaccine