Care coordination of health systems at municipality and county level in Anhui province

Objective To examine the status of care coordination for diabetes and schizophrenia patients in health systems for improving medical service coordination in hierarchical diagnosis and treatment practice.Methods With typical sampling,Ma'anshan municipality,Feidong and Feixi county in Anhui province were selected as the case study sites and totally 33 medical institutions (11 in each of the three sites)were surveyed.Theoretical service packages for diabetes and schizophrenia diagnosis and treatment were constructed through documents review and experts consultation and the medical service provided actually to the patients with the two diseases were assessed with a questionnaire survey among doctors in the institutions studied.The gaps between theoretical and actual medical service were analyzed using deficit,overlap,and excess indexes.Results There was one discontinuous segment in medical service (a service item not provided by all the institutions at different levels within the health system) to diabetes patients in each of the three health systems,two and three discontinuous segments in medical service to schizophrenia patients in health system of Feixi and Feidong county.The care coordination of the health systems showed different characteristics for medical service to diabetes and schizophrenia patients,with the over provision (excess index ≥ 4.5) in institutions at village/community level and deficit provision (deficit index ≥ 1.5) in institutions at county/municipality level for service to diabetes patients,and the deficit provision (deficit index ≥ 6.8) in institutions at village/community level and both over and deficit provision in institutions at county/municipality level for service to schizophrenia patients.Conclusion The study results suggest that care coordination in health systems in Anhui province needs to be promoted by bridging discontinuous segment in medical service,advancing cooperation among medical institutions at different level,and making comprehensive arrangement within health systems.