Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
BMC Health Serv Res. 2012 Dec 7;12:449. doi: 10.1186/1472-6963-12-449.
An aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs) to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China.
Two thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization) were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ2-test, and multiple regression analysis.
Compared with the control group, the management group demonstrated improvement on the following variables (P<0.01): health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood pressure monitoring, waist-to-hip ratio, systolic blood pressure and fasting blood sugar. The number of outpatient clinic visits did not differ significantly (P=0.60) between the two groups before intervention, while after intervention it was smaller in the management group than in the control group (P<0.01). However, the number of hospital admissions in the preceding 6 months was not different between the two groups even after intervention (P=0.36). Multiple regression analysis showed that gender, age, education level, chronic disease status and self-evaluated psychological conditions were important factors affecting health knowledge score, BMI, and waist-to-hip ratio.
Community-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health.
ChiCTR-OCH-11001716.
人口老龄化给中国的医疗保健带来了重大挑战。健康管理已被实施，以降低医疗成本，提高卫生服务利用率，增加健康知识，提高生活质量。几项研究试图在全球范围内验证健康管理在实现这些目标方面的有效性。然而，由于缺乏随机对照试验（RCT），无法得出可靠的结论。中国进行的少数小规模研究大多涉及一般人群，而不是老年人。我们的研究旨在通过在中国南京进行的 RCT，评估社区为基础的健康管理对老年人健康的影响。
共有 2400 名年龄在 60 岁或以上并知情同意的参与者被随机 1:1 分配到管理组和对照组，随机分组方案直到分配前一直对社区卫生服务中心的工作人员保密。前者接受社区为基础的健康管理，后者仅接受常规护理。18 个月后，根据问卷、临床监测和诊断测量，测量了三类变量（主观分级健康指标、客观健康指标和卫生服务利用）。干预前后比较两组之间的差异，采用 t 检验、χ2 检验和多元回归分析进行分析。
与对照组相比，管理组在以下变量上有改善（P<0.01）：健康知识评分、自我评估心理状况、整体自我评估健康状况、饮食评分、每周体力活动时间、定期血压监测、腰臀比、收缩压和空腹血糖。干预前两组门诊就诊次数无显著差异（P=0.60），而干预后管理组就诊次数明显少于对照组（P<0.01）。然而，即使在干预后，两组在前 6 个月的住院人数也没有差异（P=0.36）。多元回归分析显示，性别、年龄、教育程度、慢性病状况和自我评估心理状况是影响健康知识评分、BMI 和腰臀比的重要因素。
社区为基础的健康管理改善了主观分级健康指标、客观健康指标，并减少了门诊就诊次数，证明了改善老年人健康的有效性。
ChiCTR-OCH-11001716。
