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• W3139308237 abstract "Abstract Background: Extending the service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about the association between service scope of PCFs with patient outcomes are available. This study aims to investigate the association between service scope of PCFs and patient outcomes. Methods: We first sampled four counties randomly from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from the local information system of New Rural Cooperation Medical Scheme. The service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were 1) level of inpatient institutions, 2) length of stay, 3) per capita total health cost, 4) per capita out-of-pocket cost, 5) reimbursement ratio, 6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordered regression model were conducted to identify the association between service scope of PCFs and patient outcomes. Results: On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2% [-6.5%, -5.9%], city-level hospitals (-1.9% [-2.0%, -1.8%]), and provincial hospitals (-2.1% [-2.2%, -2.0%]), smaller rate of 30-day readmission (-0.5% [-0.7%, -0.3%]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3% [1.9%, 2.8%]) than their counterparts from communities with PCFs of least service scope. Conclusion: The service scope of PCFs varied a lot in rural Guizhou, China. PCFs' greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending the service scope of PCFs is cost-effective and sustainable." @default.
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• W3139308237 date "2021-03-18" @default.
• W3139308237 modified "2023-10-18" @default.
• W3139308237 title "Association Between Service Scope of Primary Care Facilities and Patient Outcomes: A Retrospective Study in China" @default.
• W3139308237 doi "https://doi.org/10.21203/rs.3.rs-334123/v1" @default.
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