Improving Primary Healthcare for Elderly Patients: How Chronic Disease Management Intensity Makes a Difference

Document Type : Original Article

Authors

1 School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China

2 NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China

3 Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA

4 Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia

5 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

6 Yichuan Street Community Health Service Center of Putuo District, Shanghai, China

7 Health Commission of Yuhuan, Taizhou, Zhejiang Province, China

8 The People’s Hospital of Yuhuan, Taizhou, China

Abstract

Background 
Since 2009, China has implemented a chronic disease management program within primary healthcare (PHC) institutions in response to challenges posed by an aging population. However, the effectiveness of the program has been reported as mixed, likely due to variations in PHC physicians’ efforts and the support they received from the health system and community. This multi-sector engagement was conceptualized as management intensity in this study, and its impact on the program’s effectiveness was evaluated.
 
Methods 
This study analyzed 60 885 patients under the chronic disease management program in Yuhuan, Zhejiang province, as of 2023. Management intensity, the primary predictor, was quantified by township-level residual measured based on patients’ length of follow-up after eliminating patient demographics. This approach removed the portion of follow-up length attributable to individual characteristics, leaving the residual serving as a purified exposure variable for management intensity. The outcome measures included outpatient visits, inpatient admissions, outpatient and inpatient expenses, and glycemic and blood pressure (BP) control status. Data sources included chronic disease management registration records, service records of follow-up, and electronic medical records. A two-level mixed-effects regression model was then used to examine how management intensity affected the outcomes.
 
Results 
Each unit increase in management intensity corresponded to 0.21 more PHC outpatient visits and 0.15 fewer hospital outpatient visits. Meanwhile, higher management intensity was also associated with increased utilization of PHC inpatient services (odds ratio [OR]: 0.98, 95% CI: 0.97-0.98) and decreased utilization of hospital inpatient services (OR: 1.24, 95% CI: 1.18-1.29).
 
Conclusion 
Greater management intensity correlated with better health outcomes and higher utilization of PHC services. Since multi-sector engagement strongly affected how intensively chronic diseases were managed, it was imperative for health systems and communities to actively participate in and strengthen the program by supporting physicians.

Keywords

References

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International Journal of Health Policy and Management
Volume 15, Issue 1
2026
Pages 1-12

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History

  • Received Date: 14 April 2025
  • Revised Date: 26 December 2025
  • Accepted Date: 10 March 2026
  • First Published Date: 10 March 2026
  • Published Date: 01 December 2026

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