How the health institution combinative contracting mechanism influences community residents' patient experiences in Shanghai: A comparative study of data from two cross‐sectional surveys

Abstract

Summary Objective To understand the effect of the health institution combinative contracting mechanism (which make participating residents make a “combinative contracting” involving family doctor of community health center, one secondary hospital, and one tertiary hospital) on community residents' patient experiences in Shanghai, China. Methods We conducted two questionnaire surveys (2016 and 2018) on the patient experiences of 1200 permanent residents of 12 subdistricts of Shanghai, who were selected via stratified random sampling. Of these, 926 participants were included after propensity score matching. We compared five dimensions of patient experience—accessibility, environment and facilities, service attitude and emotional support, communication and patient engagement, and service integration—before and after implementation of the health institution combinative contracting mechanism in June 2016. Furthermore, logistic regression analysis was used to explore the factors related to residents' overall experience. Results The health institution combinative contracting mechanism influenced most dimensions of residents' patient experience, such as accessibility, service attitude and emotional support, communication and patient participation, and service integration. The mechanism in general helped contracted residents obtain a better patient experience than before its implementation. Referral had a significant effect on participants' overall experience. Conclusion Contracted family doctors play active roles in improving nearly every dimension of residents' service experience, as well as their overall experience of services. The health institution combinative contracting mechanism not only increases interaction and strengthens trust between doctors and patients but also makes it possible for residents to obtain integrated health services.

Residents’ Willingness to Maintain Contracts with Family Doctors: a Cross-sectional Study in China

“…The economic burden of disease may affect patients' medical experiences and decrease their willingness to maintain contracts with family doctors. 18 In this study, most of the unemployed were either retired residents or students in campuses. The higher willingness to maintain contracts in the retired groups might be explained by their greater age; as for college students, they have higher awareness and compliance to FDCS, and campuses are generally equipped with highquality healthcare networks, which encourage them to maintain contracts.…”

The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service

“…[50][51][52] Compared with those who did not have FDs, patients having FDs were ensured to receive necessary health management services through long-term, frequent, and stable interaction with FDs. 53 Therefore, the tendency of patients communicating all relevant information concerning the treatment with physicians, and participating in the decision-making under the guidance of doctors increased after an effective discussion between them, which may provide patients who have FDs more active involvement during health care visits. Furthermore, patients enrolled in the FD contract service would be cared for by the same doctor, which would construct a continuous relationship between patients and primary physicians.…”

“…12 The continuous patient-physician relationship ensures that physicians have a better understanding of their patients as people rather than symptoms within the framework of a patient-centred approach, thus giving providers a better understanding of patients' conditions and health status. 15 This relationship is more helpful for providers to detect and assess the health risks for contracted residents, 51 contributes to expense control by reducing unnecessary hospital admissions, 54 provides more equitable and effective care, 53 enhances the service quality, 55 and improves patient satisfaction through their FDs' follow-up care, 15 which may also enhance patient loyalty to primary care. Besides, the FD service model encourages physicians to focus on comprehensive care, and the physical, emotional and social aspects of patients' condition will be taken into account during the diagnosis process, 15 which may make the services provided by the doctor closer to the service that patients expected.…”

The Relationship between Family Doctor Contract Services Policy and Perceived Participation in Primary Health Care among Chronic Disease Patients in China: The Mediating Role of the Patient Trust

“…Under this service model, the connection and communication between the physician team and the patient is gradually strengthened, helping to transform the primary care facility-based service relationship into a real patientcentered service model [43]. FD contract service model has been demonstrated to be associated with higher levels of patient perceived participation in care [44], and a study conducted in China found that implementing the FD contract service policy improved patients' perceived participation [45]. After the FD contract service policy was implemented, the doctor-patient communication improved, and personalized health management plans were developed based on patients' actual needs for health services, which increased patient's participation in primary healthcare [46].…”