The Impact of an Integrated County–Township–Village Care Model on Type 2 Diabetes Management in Resource-Constrained Areas in China: A Synthetic Control Method

Objective: The objective of this study is to evaluate county-specific changes in standardized management and glycemic control associated with an integrated county–township–village care model among patients with type 2 diabetes mellitus (T2DM) in resource-constrained areas of China. Methods: Three intervention counties that implemented an integrated county–township–village care model in 2019 were included. County-level quarterly data from 2017 to 2022 were extracted from electronic health record systems. Two outcome measures were assessed: the standardized management rate and the glycemic control rate among patients with T2DM. Synthetic controls were constructed from non-intervention counties within the same prefecture-level city. Sensitivity analyses excluding the highest-weight donor were conducted. Results: The synthetic controls approximated pre-intervention characteristics and outcome trajectories, although fit varied across counties and outcomes. Following implementation, mean standardized management rates exceeded their synthetic counterparts by 4.57, 3.96, and 4.35 percentage points in Counties Q, Y, and F, respectively. Placebo tests provided suggestive evidence for Counties Q and Y (p = 0.100 and p = 0.111) but limited evidence for County F (p = 0.750). Mean glycemic control rates exceeded their synthetic counterparts by 4.61 and 3.81 percentage points in Counties Q and F, respectively, compared with 0.83 percentage points in County Y. Estimated differences remained positive after excluding the highest-weight donor, although their magnitudes were sensitive to donor selection in some models. Conclusions: The integrated county–township–village care model was associated with improvements in selected T2DM management outcomes, with patterns varying across counties. Our findings suggest potential value in strengthening collaboration between county hospitals and primary health care institutions in comparable resource-constrained settings.