In the 1970s, China’s primary health care system was a role model for resource constrained settings. However, following economic liberalisation, the ‘barefoot doctor’ system gave way to hospital-based, curative treatment. In 2009, the government launched policies to support village doctors and provide basic public health services for a range of primary care activities including hypertension and diabetes care. Outcomes demonstrate high variation in uptake of these services and large quality gaps remain.
The proposed research will be conducted in partnership with the China Center for Disease Control. The objective is to strengthen health information systems to support maximal uptake of the essential public health services package for hypertension and diabetes care in three, diverse rural regions in China. It will be conducted in four phases and is aligned with the Institute for Healthcare Improvements ‘Framework for Going to Full Scale’.
Phase 1(set up): Rapid health system assessments and co-design of logic models for a region-specific quality improvement strategy.
Phase 2 (develop the scalable unit): Development of a ““change package”” for use in rural village clinics focussing on three evidence-based interventions from our previous research: (1) point of care decision support; (2) audit and feedback tools; and (3) quality improvement collaboratives.
Phase 3 (test of scale up); The change package will be implemented by China CDC regional staff in 60 village clinics over 2 years using a hybrid type 3 stepped wedge cluster RCT design. Outcomes will focus on adoption and implementation of the change package and improvements in case detection and optimal management rates. Normalisation process theory will assess the contextual factors that influence adoption.
Phase 4 (Go to full scale): Stakeholder forums, economic modelling and policy analysis to assist China CDC with developing a business case for large scale national implementation.”
- National Health and Medical Research Council, Australia