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Open Access Research article

The effect of community-based health management on the health of the elderly: a randomized controlled trial from China

Jianqian Chao1, Yimin Wang1, Hui Xu2, Qing Yu2, Lili Jiang1, Lin Tian1, Wenyuan Xie1 and Pei Liu3*

Author Affiliations

1 Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China

2 Hospital of Qinghuai, Nanjing, Jiangsu, China

3 Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China

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BMC Health Services Research 2012, 12:449  doi:10.1186/1472-6963-12-449

Published: 7 December 2012

Abstract

Background

An aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs) to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China.

Methods

Two thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization) were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ2-test, and multiple regression analysis.

Results

Compared with the control group, the management group demonstrated improvement on the following variables (P<0.01): health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood pressure monitoring, waist-to-hip ratio, systolic blood pressure and fasting blood sugar. The number of outpatient clinic visits did not differ significantly (P=0.60) between the two groups before intervention, while after intervention it was smaller in the management group than in the control group (P<0.01). However, the number of hospital admissions in the preceding 6 months was not different between the two groups even after intervention (P=0.36). Multiple regression analysis showed that gender, age, education level, chronic disease status and self-evaluated psychological conditions were important factors affecting health knowledge score, BMI, and waist-to-hip ratio.

Conclusion

Community-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health.

Trial registration

ChiCTR-OCH-11001716

Keywords:
Community-based health management; Randomized control trial; Elderly Chinese; Effect