Situation Analysis of Diabetes Management in China: The Application of Innovative Care for Chronic Conditions Framework

Research Objective: To conduct a situation analysis of diabetes management in China using the Innovative Care for Chronic Conditions framework (ICCC) as a analytic framework to demonstrate status and gaps in existing diabetes management. Study Design: We conducted an integrative multi-level literature review between January 1989 and September 2009 using ICCC framework comprised of macro (positive policy), meso (health care organization and community), and micro (patient interaction) levels as an analytic framework. Population Studied: Two English-language reference databases (PUBMED and PROQUEST HEALTH MANAGEMENT) were searched. Chinese-language literatures from VIP INFORMATION were identified as significant complementary resources to obtain a depth and breadth of vision. Moreover, diabetes related information on governmental health websites was searched through the Google search engine to explore the content of diabetes-related programs or activities. In total, 85 references were identified. Principal Findings: At the macro level, advocacy of effective strategies in diabetes management is rarely made to health professionals and health providers. Health care providers have no appropriate incentives for diabetes care in the current health delivery system. Moreover few collaborative efforts between governmental and non-governmental sectors were reflected. At the meso-level, the role of health care organizations in diabetes prevention and control is more significant than the role of community in China. However, some ICCC principles in the block of health care organization (i.e. strategy for quality improvement, well organized and equipped health care teams, continuity and coordination of health services and the use of information systems) are not achieved or need to be enhanced. In community, diabetes management efforts were made by community organizations and groups. No or few efforts are made toward the mobilization and coordination of resources in diabetes management. At the micro level, the partnership between patients and families, community partners, and health care teams is not well established because no formal link exists between community and health care organization. Conclusions: Today, responsibilities for diabetes management in China are mainly delegated to health care providers. This could be enhanced and complemented by increased support from the government; resources for diabetes management in the community; additional resources and structures from health organizations, and stronger partnerships between health care organizations and the community. The roles of patients and their families in diabetes management should also be elevated. Implications for Policy, Delivery or Practice: The ICCC framework can serve as the conceptual basis for chronic conditions situation analysis and health care system design.