Zhang Yuting, Tang Wenxi, Zhang Yan, Liu Lulu, Zhang Liang
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA.
Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian St, Jiangning District, Nanjing, 211198, China.
BMC Public Health. 2017 Mar 11;17(1):244. doi: 10.1186/s12889-017-4141-y.
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.
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.
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.
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.
高血压在全球影响着10亿人，是心血管疾病和肾脏疾病的主要危险因素之一。然而，高血压管理状况仍然不佳，在中国农村地区尤为如此。
2012年7月至2014年6月，在中国潜江县的6个镇开展了一项整群随机对照试验，纳入5462名35岁以上的高血压患者。6个镇被随机分为三组：第一组采用综合护理模式，包括多学科团队和持续护理协调；第二组采用综合护理模式并给予医护人员层面的经济激励；对照组采用常规护理。主要结局指标为收缩压和用SF36量表测量的健康相关生活质量；次要结局指标包括高血压相关住院率和住院费用。在2011年12月1日至2014年6月30日期间每两个月测量一次血压，在2012年7月1日和2014年6月30日测量生活质量。使用2010年7月1日至2014年8月31日期间的住院数据。该试验已在世界卫生组织国际临床试验注册平台注册，注册号为ChiCTR-OOR-14005563。
我们发现，综合护理模式可有效降低收缩压1.93 mmHg（95%置信区间0.063 - 3.8），改善自我评估的健康相关生活质量，并使高血压相关住院率降低0.17个百分点（95%置信区间0.094 - 0.24）。我们还发现，医护人员层面的经济合同可进一步降低收缩压1.76 mmHg（95%置信区间0.73 - 2.79），并降低住院率和住院费用，但也会降低患者自我评估的健康相关生活质量。
综合护理和经济激励措施在降低血压和降低住院率方面有效，但经济合同可能会损害患者的生活质量。该试验于2014年11月23日在中国临床试验注册中心注册（ChiCTR-OOR-14005563）。这是一次回顾性注册。
