School of Public Health, Fudan University, Shanghai, China.
School of Public Health, Fudan University, Shanghai, China
BMJ Open. 2023 Feb 17;13(2):e065612. doi: 10.1136/bmjopen-2022-065612.
Our study aimed to examine whether the family doctor system can improve continuity of care for patients with diabetes.
Registry-based, population-level longitudinal cohort study.
Linked data from the administrative Health Information System and the Health Insurance Claim Databases in a sample city in eastern China.
30 451 insured patients who were diagnosed with diabetes before January 2015 in the sample city, with ≥2 outpatient visits per year during 2014-2017. Diabetics in the intervention group had been registered with family doctor teams from 2015 to 2017, while those who had not registered were taken as the control group.
The family doctor system was established in China mainly to strengthen primary care and rebuild referral systems. Residents were encouraged to register with family doctors to obtain continuous health management especially for chronic disease management.
Continuity of care was measured by the Continuity of Care Index (COCI), Usual Provider Continuity Score (UPCS) and Sequential Continuity of Care Index (SECON) in 2014-2017.
COCI, UPCS and SECON of all diabetics in this study increased between 2014 and 2017. A difference-in-difference approach was applied to measure the net effect of the family doctor system on continuity of care. Our model controlled for demographic and socioeconomic characteristics, and severity of disease at baseline. Compared with the control group, diabetics registered with family doctors obtained an average 0.019 increase in COCI (SE 0.002) (p<0.01), a 0.016 increase in UPCS (SE 0.002) (p<0.01) and a 0.018 increase in SECON (SE 0.002) (p<0.01).
This study provides evidence that the family doctor system can effectively improve continuity of care for patients with diabetes, which has substantial policy implications for further primary care reform in China.
本研究旨在探讨家庭医生制度是否能提高糖尿病患者的连续性护理。
基于注册的、人群层面的纵向队列研究。
中国东部一个样本城市的行政健康信息系统和健康保险理赔数据库中的关联数据。
30451 名 2015 年 1 月前在样本城市被诊断患有糖尿病、2014-2017 年每年至少有 2 次门诊就诊的参保患者。2015-2017 年期间，干预组的糖尿病患者已在家庭医生团队注册，而未注册的患者则作为对照组。
家庭医生制度在中国主要是为了加强基层医疗和重建转诊制度。鼓励居民向家庭医生注册，以获得持续的健康管理，特别是慢性病管理。
2014-2017 年期间，所有糖尿病患者的连续性护理指数（COCI）、常用提供者连续性评分（UPCS）和连续连续性护理指数（SECON）均有所增加。采用差异法衡量家庭医生制度对连续性护理的净效应。我们的模型控制了人口统计学和社会经济特征以及基线时疾病的严重程度。与对照组相比，向家庭医生注册的糖尿病患者的 COCI 平均增加了 0.019（SE 0.002）（p<0.01），UPCS 增加了 0.016（SE 0.002）（p<0.01），SECON 增加了 0.018（SE 0.002）（p<0.01）。
本研究提供了证据表明，家庭医生制度可以有效提高糖尿病患者的连续性护理，这对中国进一步进行基层医疗改革具有重要的政策意义。
