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Chao J.,Nanjing Southeast University | Yang L.,Nanjing Southeast University | Xu H.,Hospital of Qinghuai | Yu Q.,Hospital of Qinghuai | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2015

The objective of this study was to evaluate the effect of integrated health management model on the health of older adults with diabetes. The 100 older adults with diabetes who gave informed consent were randomly allocated 1:1 into management and control groups. The integrated health management model was applied in the former while the latter was only given usual care. This model included the following components: health record establishment, health evaluation and health management (such as: diet advice, psychological aspects of health, education/skills training on health self-management, regular blood glucose monitoring, long-term diabetes drug monitoring, etc.). After 18 months, differences in three categories of variables (subjective grading items, objective measurement health indices and health service utilization) between the two groups before and after the intervention were assessed with t-test, χ2-test and mixed model analysis. The management group demonstrated improvement on the following variables: health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood sugar monitoring, waist-to-hip ratio, diastolic blood pressure and fasting blood sugar, the days of hospital admissions in the preceding 6 months. Mixed model analysis showed that gender, age, self-evaluated health status, self-evaluated psychological status, education level and resident status were important factors affecting health indices. This study demonstrated that integrated health management model was effectiveness in improving the health of older adults with diabetes. © 2014 Elsevier Ireland Ltd.


Chao J.,Nanjing Southeast University | Li Y.,Nanjing Southeast University | Xu H.,Hospital of Qinghuai | Yu Q.,Hospital of Qinghuai | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2013

The objective of this study was to evaluate the health status and associated factors of the elderly Chinese population. A cross-sectional survey was administered to 849 elderly people aged 60 years and over living in a certain district of Nanjing, China. A health rating scale based on the characteristics of the elderly in China was used. The difference of self-rated health between different groups was tested using an ANOVA, and the associated factors were tested using an ordinal logistic regression. The results showed that the general health of the elderly Chinese people studied was not good. The scores of body function, self-care ability, and physical health decreased gradually with age. The scores of men were higher than those of women in terms of emotional personality. The factors associated with the health status of the elderly were education, living mode and marital status. The health status of the elderly Chinese and the associated factors highlighted in this study demonstrated that emotional and social support were more important than financial support for promoting the mental health of the elderly. These findings will provide a basis for the development of programmes promoting the health management and healthy ageing of the elderly in China. © 2012 Elsevier Ireland Ltd.


Chao J.,Nanjing Southeast University | Wang Y.,Nanjing Southeast University | Xu H.,Hospital of Qinghuai | Yu Q.,Hospital of Qinghuai | And 4 more authors.
BMC Health Services Research | Year: 2012

Background: An aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs) to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China. Methods. Two thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization) were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ§ssup§2§esup§-test, and multiple regression analysis. Results: Compared with the control group, the management group demonstrated improvement on the following variables (P<0.01): health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood pressure monitoring, waist-to-hip ratio, systolic blood pressure and fasting blood sugar. The number of outpatient clinic visits did not differ significantly (P=0.60) between the two groups before intervention, while after intervention it was smaller in the management group than in the control group (P<0.01). However, the number of hospital admissions in the preceding 6 months was not different between the two groups even after intervention (P=0.36). Multiple regression analysis showed that gender, age, education level, chronic disease status and self-evaluated psychological conditions were important factors affecting health knowledge score, BMI, and waist-to-hip ratio. Conclusion: Community-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health. Trial registration. ChiCTR-OCH-11001716. © 2012 Chao et al.; licensee BioMed Central Ltd.


Chao J.,Nanjing Southeast University | Zong M.,Nanjing Southeast University | Xu H.,Hospital of Qinghuai | Yu Q.,Hospital of Qinghuai | And 4 more authors.
Archives of Gerontology and Geriatrics | Year: 2014

The aim of this study was to assess the long-term effects of community-based health management on elderly diabetic patients using a Markov model. A Markov decision model was used to simulate the natural history of diabetes. Data were obtained from our randomized trials of elderly with type 2 diabetes and from the published literature. One hundred elderly patients with type 2 diabetes were randomly allocated to either the management or the control group in a one-to-one ratio. The management group participated in a health management program for 18 months in addition to receiving usual care. The control group only received usual care. Measurements were performed on both groups at baseline and after 18 months. The Markov model predicted that for every 1000 diabetic patients receiving health management, approximately 123 diabetic patients would avoid complications, and approximately 37 would avoid death over the next 13 years. The results suggest that the health management program had a positive long-term effect on the health of elderly diabetic patients. The Markov model appears to be useful in health care planning and decision-making aimed at reducing the financial and social burden of diabetes. © 2014 Elsevier Ireland Ltd.

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