Evaluation of the Chronic Disease Co-Care Pilot Scheme

Conditions studied

Diabetes Mellitus, Type 2, Hypertension, Chronic Disease, Disease Management, Primary Healthcare

About this study

The Chronic Disease Co-Care (CDCC) Pilot Scheme is initiated for early screening and management of people with hypertension (HT), pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) in Hong Kong. This study will evaluate the quality of care, feasibility, acceptability, effectiveness and cost-effectiveness of the Scheme. This is a 12-month cohort study among the District Health Centre (DHC) or DHC Express, healthcare providers, CDCC participants and a comparison group of 1,886 non-participants. All the person-in charge, 2 family doctors and 1 of each allied health provider from each DHC/DHC Express will be administered with the questionnaires on quality of care and costing. All CDCC participants will be included in subject characteristics, among which a convenience sample of 548 will complete a telephone survey on experience, enablement and satisfaction of the CDCC Pilot Scheme. The health outcomes of 1,886 CDCC participants and 1,886 non-participants will be compared for evaluation of effectiveness and cost-effectiveness. Participant characteristics, enablement, compliance to the standards of care, and costing of CDCC Pilot Scheme will be summarized using descriptive statistics. Differences in the proportion of patients meeting treatment targeted for HT, pre-DM and DM after 12 months will be compared by chi-squared test and logistic regressions. The incremental cost-effectiveness ratio will be evaluated by comparing with the World Health Organization (WHO) threshold. This study will inform future healthcare planning and policy for manpower and resource allocation.

Interventions

• Combination Product: The Chronic Disease Co-Care (CDCC) Pilot Scheme — Participants will receive comprehensive health management plans and necessary medication treatment from family doctors, based on their clinical condition. Nurse clinic will provide disease prevention education, health assessment, and counselling services, whereas allied health professionals (including optometrists, podiatrists, dietitians, and physiotherapists) will provide individualized intervention services for participants.

Primary outcomes

• Characteristics of the Chronic Disease Co-Care (CDCC) participants (Characteristics of CDCC participants will be described at baseline)
• Healthcare providers' adherence to care standards on the evaluation framework by the quality of care questionnaire (Questionnaires will be implemented at 6 months and 12 months after the study begins)
• Enablement of CDCC participants by the Chinese Patient Enablement Instrument (12 months)
• Effectiveness of the CDCC Pilot Scheme on disease control for pre-diabetes mellitus (pre-DM) and DM in percent of Glycated Hemoglobin (HbA1c) and hypertension (HT) in millimeter of mercury of systolic blood pressure (SBP)/diastolic blood pressure (DBP) (12 months)
• The additional costs for delivering the CDCC Pilot Scheme by the costing questionnaire (12 months)
• The cost-effectiveness for delivering the CDCC Pilot Scheme on the incremental cost-effectiveness ratio (12 months)

Eligibility information

Study locations

• Jockey Club Building for Interdisciplinary Research 5 Sassoon Road, Pok Fu Lam, HONG KONG, Hong Kong, Hong Kong