Effectiveness and equity of a digital–enabled hospital–community hypertension management model: A quasi–experimental study in rural China
คำสำคัญ:
Hypertension, Digital health, Integrated delivery of health care, Rural health services, Chinaบทคัดย่อ
Hypertension affects approximately 1.3 billion adults globally and 245 million in China, with awareness, treatment, and control rates notably low in rural Guangxi Zhuang Autonomous Region. This study aimed to evaluate the effectiveness, underlying mechanisms, and equity of a digital-enabled hospital–community hypertension management model implemented within the medical alliance framework. A quasi-experimental design was used, with a 16-month intervention in Lingchuan County (n = 1,431) and Guanyang and Gongcheng Counties as the control group (n = 1,545). Outcomes were analyzed through baseline and endpoint surveys, on-site clinical examinations, multivariable logistic regression, and a difference-in-differences (DID) model. The intervention group's blood pressure control rate rose from 59.40% to 76.89%, compared with 45.82% to 59.69% in the control group. Logistic regression identified knowledge, alcohol consumption, and physical activity as significant predictors of blood pressure control. However, the DID interaction term was not statistically significant (β = 0.036, P = 0.734), suggesting that part of the within-group improvement may reflect secular trends or concurrent health-system changes rather than the intervention alone. These findings indicate that a digital-enabled hospital–community model can support graded care and behavioral change in rural settings, while underscoring the need for cautious causal interpretation and longer follow-up. The results offer practical guidance for refining county-level integrated care under China's Healthy China Action and the 2024 hypertension guidelines.
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