The advancement of high-quality national basic public health services continues to faces critical challenges, including insufficient quality resources in primary care and limited diagnostic and treatment capabilities. Since January 2022, Longhua District, Shenzhen initiated a pilot of the digitally enabled generalist-specialist collaborative care, aiming to enhance the capacity of primary healthcare service in managing hypertension and diabetes. This initiative leveraged the national basic public health services platform and the integration of medicine and prevention. Through policy guidance, system development, and digital support, the model sought to facilitate the efficient distribution and utilization of quality medical resources. This study presented the practical experiences of implementing the model from three key dimensions: policy mechanisms, practical measures, and early achievement. The preliminary practical achievements included: (1) Patient monitoring and enrollment: from 2022 to 2024, the proportion of hypertensive patients enrolled due to two consecutive instances of poor blood pressure control within six months was 35.3%, 37.5%, and 36.2%, respectively; the proportion of diabetic patients enrolled due to two consecutive instances of poor blood glucose control within six months was 55.5%, 64.0%, and 47.5%, respectively. (2) Specialist consultation: the timely consultation rates for hypertension and diabetes increased by 46.3% and 53.9%, respectively, in 2024, as compared to 2022, following the inclusion of the timely consultation rate in the performance evaluation of the medical consortium at the end of 2023. (3) Implementation by general practitioners: from 2022 to 2024, the timely implementation rate for hypertension increased from 73.7% to 84.3%, and for diabetes, from 73.9% to 80.8%. (4) Outcomes of patients managed by general practitioners and specialists: the average control rates during 2022 and 2024 for enrolled patients with hypertension and diabetes were 57.1% and 50.9%, respectively. The pilot experiences indicated that the digitally enabled generalist-specialist collaborative care effectively improved the management capacity of hypertensive and diabetic patients in primary care settings, contributing to better patient outcomes. At this critical juncture in advancing the high-quality development of national basic public health services, it was essential to establish implementation standards, strengthen supporting policy mechanisms and implementation strategies, and optimize the assessment and evaluation framework for basic public health services. These steps were vital to ensuring the successful nationwide adoption of this innovative policy model.
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.
To evaluate the effect of this digitally enabled generalist-specialist collaborative care model on hypertension management capacity at community health centers.
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.
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.
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.
While the effectiveness of generalist-specialist collaborative care in chronic care management has been well-documented in high-income countries, evidence from China is limited.
To systematically evaluate the effect of multidisciplinary team-based care, collaboratively provided by hospital-based specialists and community-based generalists, on hypertension and diabetic outcomes in primary care settings in China.
In October 2024, a comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data Knowledge Service Platform, VIP Database, SinoMed, covering publications from 2011-07-06 to 2024-10-14. The control group received standard health management services, while the intervention group received the collaborative model in addition to standard care. Two independent researchers performed literature screening, quality assessment, and data extraction, with consensus reached for any discrepancies. Meta-analysis was conducted using RevMan 5.4.1 and Stata 17.0 software.
Seventeen randomized controlled trials involving 21 591 participants were included, with 13 819 in the intervention group and 7 772 in the control group. Meta-analysis showed that the generalist-specialist collaborative care significantly improved outcomes for diabetic patients, including reduced glycated hemoglobin (MD=-0.72, 95%CI=-0.96 to -0.48, P<0.001) , fasting blood glucose (MD=-0.84, 95%CI=-1.04 to -0.65, P<0.001) , and 2-hour postprandial blood glucose (MD=-1.12, 95%CI=-1.52 to -0.72, P<0.001) . For hypertensive patients, the model significantly reduced systolic blood pressure (MD=-6.49, 95%CI=-7.53 to -5.44, P<0.001) and diastolic blood pressure (MD=-6.00, 95%CI=-8.89 to -3.12, P<0.001) . Subgroup analyses revealed significant differences in intervention effects across gender, age, and intervention duration. Egger's test indicated potential publication bias for glycated hemoglobin (P=0.003) and fasting blood glucose (P=0.002) .
The collaborative service model between generalist and specialists significantly improves blood pressure and blood glucose indicators in patients with hypertension and diabetes at the primary care level, and should be promoted as a key measure in chronic disease management within national basic public health services. High-quality and large community trials are needed to identify strategies to enhance an in-depth collaboration between hospital-based specialists and community-based generalists, thereby further improving population health and enhancing the efficiency of healthcare utilization.
