Association Between Service Agreements and Frequency of Primary Care Visits in a Chinese Community Health Service...

To increase the utilization of Community Health Service (CHS) centers for primary care, the Central Government of China has promoted the use of contracts-known as "service agreements" (SAs)-between patients and primary care physicians. This study sought to identify factors that predict who signed SAs and the association between SAs and frequency of primary care visits in a CHS center in Beijing.

Four years of electronic health record (EHR) data (2015 to 2018) were analyzed. Multivariate logistic regression analysis was performed to examine the tendency of patients to establish a SA. The pattern of the primary care visits between the SA and the non-SA groups was compared using Gamma regression models, controlling for demographic and comorbidity conditions. Contrast analysis was performed to assess the odds ratios of signing SAs among levels of a specific patient characteristic.

Data from 32,682 adult CHS patients were collected. Of those, 66.4% had signed a SA. Patients who were female, older, more educated, married, employed, insured, or had comorbid conditions were more likely to sign SAs. Overall, having a SA was associated with a higher frequency of primary care visits for women and older patients, but not for the young and educated patients.

The evidence provides an important consideration for reducing gaps in the use of primary care services during the nationwide transition from the fee-for-service specialty care system to the patient-centered primary care-driven medical home model.