Clinical trial NCT04073732: Family Physician Contract Services and Impacts in China Based on Physician Agency Theory
Official title: Family Physician Contract Services and Impacts in China Based on Physician Agency Theory
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Physician Behavior
Hypertension
Keywords: family physician contract services
physician agency theory
physician Behavior
family physician
health service supply
Lead sponsor: Peking University
Sponsor class: OTHER
Collaborators: name: National Natural Science Foundation of China
First posted: 2019-08-29
Enrollment: 682
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: ECOLOGIC_OR_COMMUNITY
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: 1）Family physician team participating in family physician contract services, including family doctors, nurses, public security personnel, etc.; 2) Residents, Residents who come to the community health service center

Brief summary: In June 2016, the Health Reform Office in the State Council released "the Announcement about Guiding Opinions of Promoting Family Physician Contract Services". Family Physician Contract Service is an important tool to change the health service models in primary care organizations in China. The relationship between patients and physicians can be regarded as principles and agents.

Physician agency theory has been used to study physician behaviors in economics and management. Family physician contract services regulate the principle-agent relationship between patients and physicians using a formal contract, and there are lots of potentials to employ the physician agency theory to study family physician contract services in China. In theoretical aspects, the present project will study the analysis frameworks and methods of family physician contract services in China under the capitation and global budget payment mechanisms after systematically reviewing Chinese and English literatures about the physician agency theory. In empirical aspects, the present project will collect data from family physician contract services and examine the effects of specific contract forms, incentives, and fees on family physician behaviors and their impacts on health status and medical expenditures of hypertensive and diabetic patients.

Detailed description: 1. From a theoretical point of view, using the physician agency theory to construct a family physician contract services and a family physician (team) behavior theory analysis framework and research method system suitable for China's national conditions.
2. From the empirical point of view, from the demand side, analyze the needs of the family physician contract service, the status quo, and the behavior of the visit; from the supplier, understand the behavior changes and satisfaction of the family physician (team) after the implementation of the family physician contract service Degree situation
3. From an empirical perspective, from the level of primary medical institutions, use the sample area data to analyze the impact of family physicians' signing services on the number of visits and medical expenses;
4. From an empirical perspective, using the constructed theoretical analysis framework to analyze the implementation of the Chinese family physician contract service, including incentive mechanism (income, incentive performance salary and contract service fee), family physician team composition, family bed service, etc. The impact, especially on the quality and quantity of services.
5. From the empirical point of view, taking the key monitoring population (hypertension patients as an example) as a sample, further study the family physicians' contractual services, the changes in the practice behavior of family physicians to the key monitoring population (hypertension, diabetes patients), health outcomes, medical expenses The effect is to propose policy recommendations for family physicians' contracting services and physicians' behavior in the new medical reform in the future.

Eligibility criteria: Inclusion Criteria:

* Family physician

  1. a family doctor (general practitioner), has a formal medical license, does not retire;
  2. must be directly facing the patient, participate in the patient's diagnosis, prescription, treatment and return visits, with the outpatient service as the main treatment;
  3. family doctors average weekly Must receive at least 20 patients and receive an average of no less than 2 days per week;
  4. Signing informed consent.
* Residents 1) Can complete the questionnaire independently； 2）Oral participation.

Exclusion Criteria:

* Family physician Not signing informed consent

Primary outcomes:
measure: Number of contracted residents
timeFrame: 2018.1-2019.6
measure: Average treatment time
timeFrame: 2018.1-2019.6
measure: Absolute value of diastolic blood pressure
timeFrame: 2018.1-2019.6
measure: Medical expenses for patients with hypertension
timeFrame: 2018.1-2019.6
measure: Number of service residents per day
timeFrame: 2018.1-2019.6
measure: Absolute value of systolic blood pressure
timeFrame: 2018.1-2019.6
Secondary outcomes:
Other outcomes:
Locations:
city: Shanghai
country: China
facility: Shanghai Chiangning District health commission
state: Shanghai
Study officials:
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