中国全科医学2025，Vol.28Issue(31)：3904-3911,8.DOI:10.12114/j.issn.1007-9572.2025.0047
数字化赋能全-专协同对提升社区卫生服务机构高血压管理能力的政策效应评估研究
Effect of Digitally Enabled Generalist-Specialist Collaborative Care on Hypertension Management Capacity at Community Health Centers in China:a Difference-in-Differences Analysis
摘要
Abstract
Background In January 2022,Longhua District,Shenzhen piloted a digitally enabled generalist and specialist collaborative care model to deliver consistent,continues services for patients with chronic conditions managed in community health centers.This system-level initiative integrated hospital-based specialists and community-based general practitioners through a vertically aligned care model supported by a shared digital platform.Objective To evaluate the effect of this digitally enabled generalist-specialist collaborative care model on hypertension management capacity at community health centers.Methods We employed a difference-in-difference approach to examine changes in center level outcomes before and after the model was implemented during 2021-2024.The treatment group included 84 health centers in Longhua District,and the comparison group included 448 health centers in the rest of districts that were not influenced by the policy.Health centers in treatment group used the collaborative care model to delivery follow-up services,whereas health centers in comparison groups continued to provide routine services in accordance to the National Basic Public Health Services Program Standards(Third Edition).Multivariate linear regression with district and time fixed effects was constructed,controlling for health center characteristics and adjusting for inverse probability of treatment weights,with standard errors clustered at the center level.Robustness checks were conducted to evaluate the reliability and stability of the model.Results After the implementation of the digitally enabled collaborative care model,compared to centers in comparison groups,on average,quarterly standardized hypertension management rate and hypertension control rate in the treatment group increased by 4.3-percentage-point(DID=0.043,SE=0.011,P<0.001)and 11.5-percentage-point increase(DID=0.115,SE=0.012,P<0.001)per center,respectively.On average,the quarterly number of upward referrals per center decreased by 17.1%(P=0.038),and the quarterly number of total patient visits per centers increased by 22.1%in treatment group(P=0.003),as compared to comparison groups.Conclusion Our study highlights the significance of the digitally enabled specialist and generalist collaborative care model in enhancing health center capacity in hypertension management,reducing upward referrals,and optimizing resource utilization.Our study underscores the importance of incorporating this initiative into national health strategies,such as the National Basic Public Health Services Program,to strengthen chronic care management services delivery in more areas of China.Future policies and research should focus on scaling up this approach to a broader range of medical conditions and prioritizing investments in health centers by ensuring stable funding streams and optimizing the implementation strategies for digital integration pathway.关键词
公共卫生/国家基本公共卫生服务/高血压管理/全-专协同/数字化赋能/政策效应评估Key words
Public health/National essential public health services programs/Hypertension management/Generalist-specialist collaborative care/Digitally enabled/Policy evaluation分类
医药卫生引用本文复制引用
赵洁,王奕婧,刘刚,韩昕昕..数字化赋能全-专协同对提升社区卫生服务机构高血压管理能力的政策效应评估研究[J].中国全科医学,2025,28(31):3904-3911,8.基金项目
国家自然科学基金资助项目(72404116) （72404116）
