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中国全科医学

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数字化赋能全专协同对提升基层医疗机构高血压管理能力的政策效应评估研究

赵洁1，王奕婧2，刘刚2*，韩昕昕1*   

  1. 1.518055 广东省深圳市，南方科技大学公共卫生及应急管理学院 2.518000 广东省深圳市，深圳市疾病预防控制中心
  • 收稿日期:2025-01-26 接受日期:2025-03-25
  • 通讯作者: 韩昕昕
  • 基金资助:
    国家自然科学基金项目(72404116)

The Impact of Digital Health-Enabled GP-Specialty Collaborative Care on Community Health Center Chronic Care Services Capacity in China: A Difference-in-Difference Analysis

ZHAO Jie1, WANG Yijing2, LIU Gang2*, HAN Xinxin1*   

  1. 1.School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China；2.Shenzhen Center for Disease Control and Prevention, Shenzhen 518000, China
  • Received:2025-01-26 Accepted:2025-03-25
  • Contact: HAN Xinxin
  • Supported by:
    National Natural Science Foundation of China project(72404116)
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摘要： 目的　在基本公共卫生服务基础上，评估开展数字化全专协同服务对提升基层卫生服务机构高血压管理能力的政策效应。方法　以深圳市社区卫生服务机构为研究对象，将2022年1月在深圳市龙华区实施的数字化全专协同政策试点视为准自然实验，构建PSM-DID回归模型，分析政策实施前后实验组与对照组机构之间各项管理指标的差异，通过平行趋势和稳健性检验验证模型可靠性和稳定性。结果　在数字化全专协同政策实施后，相比于对照组，实验组机构的高血压规范管理率（DID系数=0.07，SE=0.03，P=0.07）和管理人群血压控制率（DID系数=0.15，SE=0.04，P<0.01）均显著提升，向上转诊人次（DID系数=-0.21，SE=0.07，P=0.04）显著减少，机构总体就诊量（DID系数=0.18，SE=0.05，P<0.01）显著增加。结论　实施数字化全专协同显著提升了基层机构规范管理效能，改善了管理人群健康结局，有效减少了在管患者向上转诊次数，同时通过政策外溢效应将更多患者留在了基层，对分级诊疗的完善具有重要作用。未来可通过完善政策机制、建立标准化实施路径等措施，为数字化全专协同服务的全面推广提供参考，助力推进基本公共卫生服务均等化和高质量发展。

关键词: 基本公共卫生服务, 全专协同, 数字化赋能, 高血压管理, 政策效应评估

Abstract: Objective　To examine the impact of the digital health-enabled GP-specialty collaborative care on improving the capacity of hypertension management in community health centers. Methods　We employed a difference-in-differences approach to examine changes in center-level outcomes before and after the vertical integration was implemented. The treatment group included all health centers in Longhua district, which piloted the digital health-enabled GP-specialty collaborative care in January 2022, while the comparison group included centers in the rest of other districts. Multivariate linear regression with district and quarter fixed effects was used, controlling for center-level characteristics, with standard errors clustered at the district-year level. Results　After the implementation of the digital health pilot, there was a 7-percentage-point increase (P=0.09) in the standardized hypertension management rate, a 15-percentage-point increase (P<0.01) in the hypertension control rate, a 21-percentage-point decrease (P=0.04) in upward referral numbers, and a 18-percentage-point increase (P<0.01) in total patient visits among centers in the treatment district, compared to changes in these shares at centers in the comparison districts. Conclusion　Our findings highlight the potential of the digitally-enabled integration of multidisciplinary teams, which connects community-based generalists with hospital-based specialists via the digital health technology, to address gaps in chronic care management capacity of community health centers. This study underscores the importance of incorporating such integration initiatives into national health strategies, such as the National Basic Public Health Services Program, to strengthen the primary care system in more areas of China. Future policies and research should focus on expanding 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.

Key words: National basic public health services, GP-Specialty collaborative care, Digitally health-enabled, Hypertension management, Policy evaluation

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