Management capacity for stable coronary heart disease in Shanghai community medical institutions: a cross-sectional...

Coronary heart disease (CHD) remains one of the leading causes of death worldwide. However, systematic evaluations of CHD management quality at the community level remain limited, thereby constraining improvements in primary medical capacity. This study aims to evaluate community-based CHD management using Donabedian's model to optimise resource allocation, standardise clinical pathways, and improve chronic disease management.

Guided by Donabedian's model, this study assessed the quality of CHD diagnosis and management within Shanghai's primary healthcare system across three dimensions-structure, process, and outcome-from the dual perspectives of community healthcare institutions and general practitioners (GPs). A cross-sectional survey was conducted between April and May 2024, involving 247 primary healthcare institutions selected through census sampling. Within each administrative district, 50% of institutions were randomly selected using cluster sampling. Subsequently, stratified sampling based on professional titles was employed to survey 50% of GPs within these institutions. In total, 247 institutional questionnaires and 2,093 GPs' responses were deemed valid and included in the final analysis.

Structural analysis indicated adequate CHD-specialised clinics (74.8% with integrated care teams) and essential equipment availability (> 97%), but significant gaps in rehabilitation resources (personnel: 14.6%; equipment: 8.5%). Process evaluation showed high referral rates (91.5%) yet poor patient self-management (18.6%) and limited health record completeness (27.1%). Only 26.7% of institutions adopted CHD-specific information systems. GPs demonstrated strong acute care capacity but had knowledge gaps in advanced concepts (53.6%) and test interpretation (45.4%). Key barriers included equipment shortages (75.5%) and protocol adherence issues (73.1%), with prioritised solutions emphasising medical consortium collaboration (89.4%) and multidisciplinary team development (88.3%).

CHD management in Shanghai's community settings is marked by adequate provision of essential resources but notable deficiencies in rehabilitation services and digital infrastructure. Strengthening rehabilitation services, enhancing information system development, and providing targeted training to improve diagnostic and management capacities are recommended. These findings may provide valuable insights for informing similar efforts in other regions.