Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study

Post-Acute Care in China: Development, Challenges, and Path Forward

OBJECTIVES

To evaluate the evolution and challenges of China's post-acute care (PAC) system over the past 20 years and suggest actionable policy recommendations for its improvement.

DESIGN

A retrospective review of policies and initiatives aimed at PAC system development, analyzed alongside unsolved challenges in light of global PAC practices, informed by literature reviews and collaborative discussion.

SETTING AND PARTICIPANTS

PAC in China involves diverse settings such as general hospitals, inpatient rehabilitation centers, skilled nursing facilities, community health centers, and homes. The patients are mainly those discharged from acute hospitals with functional impairment and in need of continuous care.

METHOD

An extensive search of government policy documents, statistical sources, peer-reviewed studies, and the gray literature. The research team conducted literature reviews and discussions regularly to shape the findings.

RESULTS

China has strengthened its PAC system through improved rehabilitation and nursing infrastructure, establishment of tiered rehabilitation networks, and adoption of innovative payment methods. However, challenges persist, including a lack of clinical consensus, resource constraints in PAC facilities and among professionals, the need for integrated care coordination, and the unification of PAC assessment tools and payment mechanisms.

CONCLUSIONS AND IMPLICATIONS

Although China has made substantial progress in its PAC system over 2 decades, continued efforts are needed to address its lingering challenges. Elevating awareness of PAC's significance and instituting policy adjustments targeting these challenges are essential for the system's optimization.

Aging in Place or Institutionalization? A Multiscale Analysis of Independent-Living Older Adults From Four Large Cities in China's Yangtze River Delta

Background and Objectives

Aging in place (AIP) has been adopted as a key strategy to cope with the global public health challenge posed by population aging. The current study aimed to understand the association between older adult's AIP preference and various social and physical environmental factors at different scales.

Research Design and Methods

Following the ecological model of aging, this paper conducted a questionnaire survey of 827 independent-living older adults (60 years old and above) from four big cities in China's Yangtze River Delta region and employed a structural equation modeling method for analysis.

Results

Older adults from more developed cities exhibited a stronger preference for AIP than those from less developed cities. Individual characteristics, mental health, and physical health had a direct impact on AIP preference, whereas the effect of the community social environment was not significant. The perceived and objectively measured community-built environment indirectly affected AIP preference via mediation and chain effects.

Discussion and Implications

Complex paths affecting AIP preference were identified. At the city level, the social environment had a stronger influence than the physical environment on AIP, and the opposite pattern was observed at the community level. Mental health and physical health had opposite effects on AIP preference. Although physical health was negatively associated with AIP, age-friendly communities with compact, diverse, and accessible built environments have a positive impact on older adults' physical health and therefore should be promoted.

Factors influencing choice of health system access level in China: A systematic review

OBJECTIVE

In China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities.

METHODS

We screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients' choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study's characteristics, methodology, and factors.

RESULTS OF DATA SYNTHESIS

The results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors 'drug variety' and 'equipment', and composite factor 'perceived quality', push patients from lower levels towards higher levels.

CONCLUSION

Underuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions.