TY - JOUR
T1 - The quality of primary care in community health centers
T2 - Comparison among urban, suburban and rural users in Shanghai, China
AU - Shi, Jianwei
AU - Jin, Hua
AU - Shi, Leiyu
AU - Chen, Chen
AU - Ge, Xuhua
AU - Lu, Yuan
AU - Zhang, Hanzhi
AU - Wang, Zhaoxin
AU - Yu, Dehua
N1 - Funding Information:
The design of this study was supported by the Shanghai Excellent Young Talents Project in Health System (2018YQ52). Data extraction and analysis was funded by the Natural Science Foundation of China (71774116; 71603182). The interpretation of data guided by the statisticians were funded by grants from the National Key R&D Program of China (2018YFC2000700) and Shanghai Medicine and Health Development Foundation (Se1201931). The writing and revision, including the language improvement, were sponsored by Shanghai Pujiang Program (2019PJC072) and Shanghai Leading Talents Program (YDH-20170627).
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/8/27
Y1 - 2020/8/27
N2 - Objective: Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. Findings: A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs. Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
AB - Objective: Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. Findings: A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs. Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
KW - Community health centers
KW - PCAT
KW - Primary care
KW - Quality
UR - http://www.scopus.com/inward/record.url?scp=85090014599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090014599&partnerID=8YFLogxK
U2 - 10.1186/s12875-020-01250-6
DO - 10.1186/s12875-020-01250-6
M3 - Article
C2 - 32854623
AN - SCOPUS:85090014599
SN - 1471-2296
VL - 21
JO - BMC Family Practice
JF - BMC Family Practice
IS - 1
M1 - 178
ER -