Chronic disease management: policy design based on service design methods

Chronic diseases, such as hypertension and diabetes, impose significant burdens on health systems and communities.

To inform implementation-oriented public health strategies, this study utilized a mixed-methods design that integrates population-level administrative data, patient-reported experiences, and qualitative inquiry in Xiling District, Yichang, China. The data sources included 93,146 adults with hypertension and 32,050 adults with diabetes from the district's chronic disease management information system, a survey of 518 patients, and qualitative data from semi-structured interviews (n = 10) and focus group discussions (n = 19). The analytic approach employed descriptive statistics to construct and assess care cascades for diagnosis, enrollment, standardized management, treatment, and clinical control, alongside reflexive thematic analysis of qualitative data, with findings synthesized through a service-design lens.

The findings indicated (1) significant drop-offs along care cascades, particularly in enrollment in basic public health services and standardized management; (2) user-journey evidence suggesting limited process visibility, low perceived value of follow-up services, and fragmented information flow, which elucidate the observed cascade gaps; and (3) stakeholder feedback highlighting inadequate coordination among service providers.

By synthesizing quantitative and qualitative insights, the study proposes a three-layer service-design framework-users, service processes, and service provision-to guide the redesign of chronic disease management services. These findings illustrate how the integration of administrative data with user experience insights can lead to more actionable and user-centered policy design.