Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China.
The Third People's Hospital of Foshan, Foshan Mental Health Center, Foshan, Guangdong, China.
Int J Equity Health. 2023 Jun 7;22(1):114. doi: 10.1186/s12939-023-01929-z.
In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients' PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China.
Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China's Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients' PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients' PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates.
The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C-First-contact care-which assesses access (2.98 ± 0.03), and D-Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07-0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27-0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03-0.16).
Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.
在中国，社区卫生服务中心（CHC）提供基本医疗保健（PHC）；然而，很少有研究调查移民患者所经历的 PHC 服务质量。我们调查了 CHC 实现以患者为中心的医疗之家（PCMH）与移民患者 PHC 体验质量之间的潜在关联。
2019 年 8 月至 2021 年 9 月，从中国大湾区的十家 CHC 招募了 482 名移民患者。我们使用全国质量保证患者为中心的医疗之家（NCQA-PCMH）问卷评估 CHC 服务质量。我们还使用初级保健评估工具（PCAT）评估了移民患者 PHC 体验的质量。使用一般线性模型（GLM）调整协变量后，考察了 CHC 实现 PCMH 与移民患者 PHC 体验质量之间的关联。
所招募的 CHC 在 PCMH1、以患者为中心的准入（7.2±2.0）和 PCMH2、团队合作护理（7.4±2.5）方面表现不佳。同样，移民患者对 PCAT 维度 C-首次接触护理-评估准入（2.98±0.03）和 D-持续护理（2.89±0.03）的评分较低。另一方面，高质量的 CHC 与更高的总 PCAT 和维度得分显著相关，维度 B 和 J 除外。例如，CHC PCMH 水平每增加一级，PCAT 总分增加 0.11（95%CI：0.07-0.16）。我们还发现，老年移民患者（>60 岁）与总 PCAT 和维度得分之间存在关联，除了维度 E。例如，随着 CHC PCMH 水平的增加，老年移民患者维度 C 的平均 PCAT 评分增加了 0.42（95%CI：0.27-0.57）。在年轻的移民患者中，这一维度仅增加了 0.09（95%CI：0.03-0.16）。
在高质量 CHC 接受治疗的移民患者报告了更好的 PHC 体验。所有观察到的关联在老年移民中更强。我们的研究结果可能为未来关注移民患者基本医疗服务需求的医疗保健质量改进研究提供信息。
