General Information
We established the IGPDP prospective study cohort and conducted the study for 24 months. Random sampling was used for sampling. Patients who visited each community health service center within one month and met the inclusion criteria were included in this study, until the number reached the required number.
The sampling steps were as follows: First, the experiment was conducted in Shenyang, Liaoning Province, China. The sampling frame of this study were the lists of districts and community health service centers in Shenyang. We selected 5 administrative districts with populations of more than 100,000, and we selected community health service centers in these administrative areas with an average daily outpatient volume of more than 50 people. Then, according to the population distribution of Shenyang, a certain number of community health service centers were randomly selected in each administrative region to be included in this study (Table 1) [11, 12]. Finally, the subjects were randomly divided into a control or test group. In Dadong District, Heping district, and Shenhe District, half of the community health centers were randomly selected as the control group, and the other half were selected as the test group. At the community health centers in Huanggu District and Tiexi district, half of the study subjects were randomly selected as the control group, and the other subjects were selected as the test group (Table 1). The Medical Ethical Commission of the China Medical University approved this study. We obtained written consent from the study participants.
Table 1 Source and grouping of research samples
Inclusion and exclusion criteria
A prospective cohort study was carried out, and the inclusion and exclusion criteria are shown in the table below (Table 2). The population with risk factors for dyslipidemia was selected as the research population. Overweight or obesity, current smoking habits, unhealthy diets, and sedentary lifestyles were inclusion criteria. People who were older than or equal to 80 years old or younger than 18 years old, who had been clearly diagnosed with cardio-cerebrovascular diseases (myocardial infarction, stroke), lung cancer, and chronic obstructive pulmonary disease, who are unable to adhere to treatment or use other treatment methods that affected the data collection and efficacy assessment, who were pregnant or lactating, or who had with a genetic dyslipidemia disorder were excluded.
Table 2 Inclusion and exclusion criteria
Intervention methods
IGPDP was used in the test group, and the traditional health management service model was used in the control group. In the control group, an annual physical examination was carried out according to the medical examination package for the subjects, group health consultation was provided for the subjects, and coordinate specialist referral was required. In the test group, the one-year intervention cycle was divided into a two-month strengthening phase, a one-month consolidation phase, and a nine-month stable phase (Fig. 1). According to the individual condition of the subjects, we designed a health plan for them and provided personalized diet and exercise guidelines according to the plan. After a period of intervention, the health plan was modified or reformulated according to changes in the subjects' health status. The effect of implementation was evaluated by analyzing the subjects' questionnaire results and clinical indicator results at baseline, 12 months, and 24 months (Fig. 2).
Fig. 1 Health management cycle
Fig. 2 Technology roadmap
Evaluation index system
We evaluated the effect of IGPDP from three perspectives: "disease prevention", "health protection", and "health promotion”. The results at baseline, 12 months after intervention, and 24 months after intervention were collected by measuring clinical indicators and questionnaires. The data were collected by trained investigators (Table 3).
Table 3 Evaluation index system
Specific information of questionnaires
When formulating an index system for evaluating the effectiveness of health management services, we used evidence-based methods to study a large amount of literature, learn from advanced health management experiences around the world, and hire multidisciplinary senior experts. From multiple angles and multiple dimensions, the main measurable and quantifiable indicators that could reflect the difference between the two health management models were selected within the research time limit.
Health risk assessment questionnaire
This questionnaire was used to collect the subjects' basic information, behavioral risk factors, biological risk factors, and other related indicators. The questionnaire included the subjects' basic information, disease history, family history, tobacco use, alcohol consumption, daily diet and exercise, sleep quality, psychological status, living environment, and basic physical indicators (waist circumference, BMI, blood pressure, blood lipid, fasting blood glucose, etc.).
National Residents' Health Literacy Monitoring Questionnaire
This questionnaire was used to measure participants' health literacy. The questionnaire covers three dimensions: basic knowledge and concept, healthy lifestyle and behavior, and basic skills. This questionnaire is specifically divided into six categories: health science concept, prevention and treatment of infectious diseases, prevention and treatment of chronic diseases, basic medical treatment, safety and first aid, and access to health information. The scoring standard of the questionnaire is 1 point for each question of judgment and single-choice questions, and two points are given for each multiple-choice question. Patients scoring greater than 80% accuracy are considered to have health literacy [13].
Health status SF-36 Questionnaire
This questionnaire was used to measure the quality of life of the subjects. This questionnaire comprehensively measured the quality of life of the subjects from 8 perspectives: physical enginery, physiological function, physical pain, general health, energy, social function, emotional function, and mental health. In addition, this questionnaire also included health change indicators to evaluate the overall changes in the subjects' health status over the past year. According to the choice weight or score of the SF-36 questionnaire, the total score of SF-36 was 145.
Basic Health Service Demand Questionnaire
This questionnaire was used to investigate the needs of community residents for basic medical and health services. The questionnaire included three aspects: basic medical and health service, general practitioner, and community health service center. This questionnaire provided a reference for improving the services of general practitioners and allowing them to better meet the needs of the public.
We verified the reliability and validity of the questionnaire items. We also carefully designed each indicator item, the total evaluation item, and subindicator item for the research question to confirm each other. We analyzed the reliability of this questionnaire based on a small sample of survey data and tested the comprehensibility of each survey index. We sent the questionnaire to the relevant industry experts, and we asked the industry experts to check and correct it to ensure the scientific and structural rationality of the index system. We standardized the research process and avoided random filling-in. We chose the subjects carefully and emphasized the importance of the research data. We prevented the subjects filling in the data at will, trying to maintain the rigor and objectivity of the survey data.
Statistical analysis
Each monitoring and investigation in this study underwent the process of data cleaning, data verification, and standard database establishment. Epidata 3.1 software was used to establish a database. Logical error checking was conducted after data entry, and the outliers, such as missing values, singular values and extreme values, were returned to the original research institution for verification against the original questionnaire. Then, we randomly selected data at a rate of 20% and verified these data with the original data. Each research subject had finished the observation and follow-up, and the data had been retrieved, entered, and verified. After ensuring that that the database was correct, we locked the database for statistical analysis. Under normal circumstances, the data cannot be modified again. SPSS 22.0 software was used for statistical analysis of the data. The measurement data are described as the mean ± standard deviation, and the rate was used to describe the counting data. We used the rate to calculate the proportion of a certain type of patient in the total population. The numerator is the number of patients of a certain type, and the denominator is the total number in the population. The chi-squared test was used to compare the rates. The changes in behavioral risk factors of current smoking habits, unhealthy diets, sedentary lifestyles, changes in health literacy levels, and proportion of people who were willing to accept general practitioners in different study groups were compared by the chi-squared test. The t-test of two independent samples was used to compare the measurement data between the two groups. The comparison of the BMI levels in obese people, comparison of the blood lipid levels in people with dyslipidemia, and changes in the total score of the quality of life assessment in the different study groups were compared by T test. Test level α = 0.05.