Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study
Notice bibliographique
Résumé
BACKGROUND: Although many studies have investigated the relationship between the introduction of the New Cooperative Medical Scheme (NCMS) in rural China in 2003 and increased use of medical services, the effect on health status, objectively measured, is seldom reported. In Anhui Province a chronic disease scheme (CDS) for reimbursing part of the cost of outpatient care is designed to improve management of those with chronic conditions, including diabetes. METHODS: A follow-up study was designed in which patients with diabetes aged 40-70 years who had recently (in 2010) been granted a chronic disease card were individually matched on age, sex and village with a patient with diabetes not yet in the scheme. Each subject gave a fingertip sample of blood to give the concentration of glycosylated hemoglobin (HbA1c), a measure indicating blood glucose control during the previous 3 months. This measure was made on recruitment and at 12 month follow-up: information on use of health services, quality of life and financial burden was also collected at the two contacts. RESULTS: Of 602 pairs initially recruited, 528 pairs were contacted at follow-up and are the subject of this report. To distinguish between outcomes associated with application and those of membership of the scheme, the primary analysis was of 256 pairs in which one had been a member of the CDS throughout and the other never applied. No difference between pairs on HbA1c was found either at recruitment or follow-up but those in the CDS reported more hospital visits, more tests and more use of high level hospitals. However they had poorer scores on quality of life scales (SF-12, EQ-5D) and were more likely to report that the financial costs were very burdensome. Those recently applying for the scheme, or being accepted since recruitment, had lower HbA1c scores. CONCLUSIONS: On-going membership of the CDS was associated with increased use of services but this did not appear to result in better management of blood glucose or improved quality of life. Those who had recently joined the scheme had signs of improvement, suggesting a need for active follow-up to maintain and reinforce early gains.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».