Development and Validation of a Model to Predict the Contract Service of Family Doctor: A National Survey in China

Abstract

BackgroundPrevious studies have reported a relatively low utilization of family doctor contract services (FDCS) in China, while the associated factors are unknown. The current study aimed to explore the factors associated with the utilization of FDCS, and then developed and validated a predictive model based on these identified factors.MethodsWe conducted a nationwide cross-sectional study using an online questionnaire, from March 2019 to April of 2019. Routinely collected variables in daily practice by family doctors were used to develop a derivation model to determine the factors associated with FDCS utilization, and then the external performance of the model was tested.ResultsA total of 115,717 and 49,593 participants were included in the development and validation datasets, respectively. Nearly 6.8% of the participants who signed a contract with FDCS received healthcare services from family doctors in China. Factors associated with the utilization of FDCS included age, male sex, self-reported household income, education attainment, insurance status, self-reported health status, smoking, drinking, self-reported physical activity status, chronic disease, walking distance from the nearest community center, and illness in the last 2 weeks, with an area under the receiver operating characteristic curve (AUC) of 0.660 [95% confidence interval (CI), 0.653–0.667] and good calibration. Application of this nomogram in the validation dataset also showed acceptable diagnostic value with an AUC of 0.659 (95% CI, 0.649–0.669) and good calibration.ConclusionTwelve easily obtainable factors in daily practice of family doctors were used to develop a model to predict the utilization of FDCS, with a moderate performance.

Associations between the signing status of family doctor contract services and cervical cancer screening behaviors: a cross-sectional study in Shenzhen, China

“…FDCS is a core part of the primary healthcare system opening to the general public. The signing rate of FDCS in the current study was 54.3%, which was similar to the findings in Guangdong (54.7%) and Zhejiang province (50.43%) [ 14 , 15 ], but much higher than that from a nationwide survey in mainland China (approximately 6.0% in the female population) [ 16 ]. Researchers also found lower signing rates among people over 60 years old (28.2%) and with chronic diseases (29.3%) in rural China [ 17 , 18 ].…”

The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: A cross-sectional study

“…The team offers a variety of primary health care services to local residents who contract with the FDCS, such as chronic disease management, physical examinations, referrals, health consultations, and so on. [ 17 18 ]…”

Family-based improvement for health literacy among the Yi nationality (FAMILY) in Liangshan: protocol of an open cohort stepped wedge cluster randomized controlled trial

“…In addition, many foreign studies also showed that in less developed countries and regions such as sub-Saharan Africa, tribal culture similar to the family branch system was also critical in environmental protection and HIV prevention and control [ 15 , 16 ]. Meanwhile, Contracted Family Doctor Services [ 17 , 18 ] is conducted throughout the state in accordance with the unified requirements of the National Health Commission in Liangshan Prefecture. An important part of this work is to build an interactive platform for family doctors and contracted residents, providing services such as appointments, consultation, health management, and follow-up visits for NCDs.…”