title: Integrated care delivery and health care seeking by chronically-ill patients - a case-control study of rural Henan province, China.
abstract: OBJECTIVE
  This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China.
  
  
  METHODS
  A case-control study was carried out in six health care organizations from two counties in Henan province, China. 371 patients aged 50 years or over with hypertension or diabetes who visited either community health centers or hospitals in the Intervention or Control Counties were systematically selected and surveyed on health care seeking behavior, quality of care, and pathway of care for their major chronic condition. Bivariate analyses were performed to compare quality and value of care indicators between patients from the Intervention and Control Counties. Multivariate analyses were used to confirm these associations after controlling for patients' demographic and health characteristics.
  
  
  RESULTS
  Patients in both the Intervention and Control Counties chose their current health care providers primarily out of concern for quality of care (provider expertise and adequate medical equipment) and patient-centered care. Compared with the patients from the Control County, those from the Intervention County performed significantly better on almost all the quality and value of care indicators even after controlling for patients' demographic and health characteristics. Significant associations between types of health care facilities and quality as well as value of care were also observed.
  
  
  CONCLUSIONS
  The study showed that the Integrated Care Delivery Model was critical in guiding patients' health care seeking behavior and associated with improved accessibility, continuity, coordination and comprehensiveness of care, as well as reducing health inequities and mitigating disparities for older patients with chronic conditions.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland, 21205, USA. lshi@jhsph.edu.
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. mmakinen@r4d.org.
authors.forename: Marty
authors.initials: M
authors.lastname: Makinen
authors.affiliation: Department of Information Management, Da-Yeh University, Changhua, 51591, Taiwan, R.O.C.. dclee@mail.dyu.edu.tw.
authors.forename: De-Chih
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. rkidane@r4d.org.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kidane
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. nblanchet@r4d.org.
authors.forename: Nathan
authors.initials: N
authors.lastname: Blanchet
authors.affiliation: Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore, Maryland, 21205, USA. hliang16@jhu.edu.
authors.forename: Hailun
authors.initials: H
authors.lastname: Liang
authors.affiliation: Department of Social Medicine and Health Care Management, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun City, Jilin, China. jhli@jlu.edu.cn.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Li
authors.affiliation: The World Bank, 1225 Connecticut Avenue NW, Washington, DC, 20433, USA. mlindelow@worldbank.org.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindelow
authors.affiliation: Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA. Hong.Wang@gatesfoundation.org.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Henan Provincial Health Bureau, Zhengzhou, China. xieshuangbao@126.com.
authors.forename: Shuangbao
authors.initials: S
authors.lastname: Xie
authors.affiliation: School of Public Health, Zhengzhou University, Zhengzhou, China. jianwu17@163.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000379:methods* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires