Digitally enabled GP-specialist collaborative care helped improve hypertension outcomes and reduced hospital referrals in China

Abstract

As China deepens health system reform to strengthen primary care by integrating hospital-based specialist services into community settings, empirical evidence is still limited. This quasi-experimental difference-in-differences analysis examined the effect of the digitally enabled GP-specialist collaborative care model implemented in Shenzhen since January 2022, using 2021–2023 electronic health records of hypertensive adult patients receiving care at community health centers. The implementation of this collaborative care model was significantly associated with reduced quarterly mean diastolic and systolic blood pressure levels (difference, −0.84 mmHg and −0.73 mmHg), a 4.6-percentage-point increase in blood pressure control, and a 6.7-percentage-point decrease in hospital referral, with larger effects observed among women, the elderly, unemployed and those with diabetes. Digitally enabled GP-specialist collaborative care could improve care efficiency and hypertension outcomes in primary care settings, but more efforts, such as payment reform and incentive alignment, are still needed to sustain long-term implementation at scale.