[Multilevel Analysis of Value Alignment With Medical Care and Prevention Integration Among Family Doctors and Health Status of Chronic Disease Patients: The Mediating Role of Team Cohesion].

Objective: To explore the association between the value alignment with medical care and prevention integration among family doctors and the health status of patients with chronic diseases, and to analyze the mediating effect of team cohesion between them. Methods: SA survey was conducted in 4 cities in the eastern, central and western regions of China. In each city, chronic disease patients and their contracted family doctors were enrolled in 6 randomly selected townships or neighborhoods. Self-developed scales were used to assess the value identification with medical care and prevention integration among family doctors, as well as their team cohesion. The Chinese version of the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire was used to assess the health status of patients. A multilevel regression model was applied to analyze variables at two levels-patients and family doctors. The mediating effect was analyzed using a multilevel structural equation model. Results: A total of 5855 patients with chronic diseases and 164 family doctors were included. The correlation between value alignment with medical care and prevention integration among family doctors and the health status of patients was statistically significant (β = 0.089, 95% CI: 0.042-0.136). Team cohesion played a mediating role between them (P = 0.030), accounting for 5.23% of the total effect, with an indirect effect value of 0.054 and a 95% bootstrap confidence interval of 0.005-0.103. Conclusion: IIt is important to establish appropriate performance evaluation and incentive mechanisms and team collaboration mechanisms in the promotion of medical care and prevention integration, so as to improve the effect of health management for patients.