Community-based integrated medical and elderly care in Chengdu, China: organisational heterogeneity, service-capacity and service-receipt patterns, and implications for care continuity

Abstract

Community-based integrated medical and elderly care (IMEC) has expanded in China, but its organisational capacity, information-related service functions and acceptability among older adults remain insufficiently understood. These issues are relevant to care continuity because integrated care depends not only on organisational arrangements but also on the ability to maintain usable health information and coordinate services across care settings. In a cross-sectional study conducted in Chengdu between October 2023 and May 2024, we analysed two parallel surveys: an institutional survey that initially covered 132 registered IMEC institutions, of which 127 were included in the final analysis, and a household survey of 2,525 adults aged ≥65 years recruited from selected communities. We presented institutional service-capacity indicators and residents’ reported service receipt and perceived importance in parallel across selected care domains and used multivariable logistic regression to examine factors associated with willingness to choose community-based IMEC. Size-standardised analyses showed that medical-run care institutions had higher medical-bed proportions and medical staffing densities per 100 beds, whereas care-run medical institutions had a higher proportion of long-term-care beds. Elderly-care attendant density per resident did not differ significantly between the two models. Overall service-portfolio breadth was similar between the two organisational models. Overall, 68.8% of residents reported willingness to choose community-based IMEC. Higher willingness was associated with greater perceived need for convenient home/community medical services and awareness of community-based integrated care. Parallel descriptive analyses showed substantial perceived-need–capacity differences within institutions and importance–receipt differences among residents, particularly for home-based medical services, rehabilitation, psychosocial support and related community-oriented functions. Community-based IMEC in Chengdu showed substantial organisational heterogeneity, while the two surveys identified distinct service-capacity and service-receipt patterns relevant to ageing in place and care continuity. Strengthening community-oriented service packages, service visibility and information-related capacities may better support ageing in place and future data-supported continuity of care.