Avoidable hospitalizations for type 2 diabetes and hypertension in rural areas of central and western China

Abstract

Background: High-quality primary health care (PHC) can reduce complications from chronic diseases by providing timely, effective, and continuous interventions, thereby preventing hospitalizations due to disease progression. However, there has been limited evidence on avoidable hospitalizations in rural areas of central and western China.

Objective: This study aims to localize the measurement of avoidable hospitalizations tailored to China's context and assess the quality and efficiency of PHC in rural areas of central and western China among patients with type 2 diabetes or hypertension.

Methods: Data from 61,450 hospitalizations related to hypertension and diabetes were extracted from the medical records of three county-level hospitals in two provinces between 2017 and 2021, using ICD-10 diagnostic codes. Two types of avoidable hospitalizations were defined: (type I) PHC preventable but not avoidable hospitalization; (type II) PHC preventable and avoidable hospitalization. A multilevel logistic regression model was used to identify the factors influencing avoidable hospitalizations.

Results: Between 2017 and 2021, 18.1 % of diabetes-related hospitalizations and 49.6 % of hypertension-related hospitalizations were preventable by PHC but not avoidable (type I). Meanwhile, 8.1 % of diabetes-related hospitalizations and 2.4 % of hypertension-related hospitalizations were preventable by PHC and avoidable (type II). Avoidable hospitalizations for these two chronic conditions at the three hospitals resulted in an estimated financial loss of approximately 2.37 million yuan per year. Factors influencing avoidable hospitalizations for diabetes included demographic characteristics and health status, while for hypertension, additional factors included medical insurance coverage and distance to the hospital.

Conclusion: The quality of PHC for chronic diseases in rural counties of central and western China remains suboptimal, with inefficiencies and significant resource waste. Strengthening PHC quality should be a key strategy for future chronic disease management in rural China.

Keywords

Avoidable hospitalizations / Rural health / Chronic diseases / Primary health care / Central and western China

Declarations

Not applicable.

Authors' contributions

Conceptualization, L.M. and L.X.; Methodology, L.M. and L.X.; Data curation, Z.X., L.M., C.X., Z.B., C.H., T.H., Z.H.,; Formal analysis, L.M.; Funding acquisition, not applicable; Project administration, not applicable; Resources, not applicable; Supervision, L.X.; Validation, L.X.; Writing—original draft, L.M.; Writing—review and editing, Z.H., L.X., Z.X., T.H. and Z.H. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

The study received approval from Peking University Health Science Center Biomedical Ethics Committee (IRB00001052-22155).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

This research was supported by grants from China Scholarship Council (202306010282).

Authors' other information

Not applicable.

Competing interests

All authors declare that there are no competing interests.

Acknowledgements

Not applicable.

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