title: Effects of integrated chronic care models on hypertension outcomes and spending: a multi-town clustered randomized trial in China.
abstract: Hypertension affects one billion people globally and is one of the leading risk factors for cardiovascular and renal diseases. However, hypertension management remains poor, especially in rural China.
  
  
  
  A clustered randomized controlled trial was conducted in six towns in China's Qianjiang county between 7/2012 and 6/2014, including 5462 hypertension patients above 35 years old. Six towns were randomly assigned to three groups: Group 1 had the integrated care model including a multidisciplinary team and continuous care coordination, Group 2 had both the integrated care model and provider-level financial incentives, and the control group had the usual care. Primary outcomes were systolic blood pressure and health-related quality of life measured by SF36; secondary outcomes included hypertension-related hospitalization rate and inpatient spending. Blood pressure was measured sixteen times bimonthly between 12/1/2011 and 6/30/2014, and quality of life was measured on 7/1/2012 and 6/30/2014. Inpatient data between 7/1/2010 and 8/31/2014 were used. This trial is registered at the World Health Organization's International Clinical Trials Registry, number ChiCTR-OOR-14005563.
  
  
  
  We found that the integrated care model effectively lowered blood pressure by 1.93 mmHg (95% CI 0.063-3.8), improved self-assessed health-related quality of life, and reduced the rate of hypertension-related hospitalization by 0.17 percentage points (95% CI 0.094-0.24). We also found that the provider-level financial contract further lowered blood pressure by 1.76 mmHg (95% CI 0.73-2.79) and reduced rates of hospitalization and inpatient spending, but it also reduced patients' self-assessed health-related quality of life.
  
  
  
  Integrated care and financial incentives are effective in lowering blood pressure and reducing hospitalization rate, but financial contracts may hurt patient quality of life. This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563) on November 23, 2014. It was a retrospective registration.
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian St, Jiangning District, Nanjing, 211198, China.
authors.forename: Wenxi
authors.initials: W
authors.lastname: Tang
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China.|Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, 430030, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Economics, University of Pittsburgh, 230 S. Bouquet St, Pittsburgh, PA, 15260, USA.
authors.forename: Lulu
authors.initials: L
authors.lastname: Liu
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China. zhangliang@mails.tjmu.edu.cn.|Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, 430030, China. zhangliang@mails.tjmu.edu.cn.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002681:China; D016000:Cluster Analysis; D017281:Cost of Illness; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000628:therapy*; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
keywords: China; Clustered randomized trial; Hypertension; Integrated chronic care model