Box-plots for the quality of matching.

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010–2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan–Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13–1.39) and 22.97 (95% CI, 20.91–25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86–0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88–0.99) and 0.80 (95% CI 0.73–0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.</div

Outlines of Community based Registration and Management of Hypertension and type 2 Diabetes mellitus Project (CRMHDP).

Outlines of Community based Registration and Management of Hypertension and type 2 Diabetes mellitus Project (CRMHDP).</p

Differences in all-cause mortality and complications (stroke, acute myocardial infarction, and chronic renal failure) related to hospitalisations between the intervention and control groups, using the Kaplan–Meier curve, during the 5-year follow-up period.

Differences in all-cause mortality and complications (stroke, acute myocardial infarction, and chronic renal failure) related to hospitalisations between the intervention and control groups, using the Kaplan–Meier curve, during the 5-year follow-up period.</p

Trends of annual visits to the clinics per person and annual days covered for antihypertensive, antidiabetic drugs, or insulin injections per person in intervention and control groups during the period of two years prior to and five years after the baseline period.

Trends of annual visits to the clinics per person and annual days covered for antihypertensive, antidiabetic drugs, or insulin injections per person in intervention and control groups during the period of two years prior to and five years after the baseline period.</p

Hazard ratios for the intervention group vs. the control group for all-cause death and complications (stroke, acute myocardial infarction, and chronic renal failure) during the five-year follow-up period based on the Cox proportional hazard model (among excluded the pre-existing complications).

Hazard ratios for the intervention group vs. the control group for all-cause death and complications (stroke, acute myocardial infarction, and chronic renal failure) during the five-year follow-up period based on the Cox proportional hazard model (among excluded the pre-existing complications).</p

Baseline patient demographic and clinical characteristics of propensity score-matched intervention and control patients in the study (excluded prior to any complications existing).

Baseline patient demographic and clinical characteristics of propensity score-matched intervention and control patients in the study (excluded prior to any complications existing).</p

Balance in the measured baseline variables before and after matching (excluded prior to any complications existing).

Balance in the measured baseline variables before and after matching (excluded prior to any complications existing).</p

Balance in measured baseline variables before and after matching (included prior to any complications existing).

Balance in measured baseline variables before and after matching (included prior to any complications existing).</p

Flowchart of study subjects.

CRMHDP: Community based Registration and Management for Hypertension and type 2 Diabetes Mellitus Project * Covariates: gender, age, income level, presence of coexisting condition, type of physician speciality, type of public health security and medication adherence during the past two years before baseline years.</p

Difference-in-differences regression, including covariates of effects of the CRMHDP on the annual visits to clinics and annual days covered per person, with the control group matched by propensity scores.

Difference-in-differences regression, including covariates of effects of the CRMHDP on the annual visits to clinics and annual days covered per person, with the control group matched by propensity scores.</p