Abstract
BACKGROUND: Annual health examinations for older adults and patients with chronic diseases at community health service centers play a crucial role in early disease detection and complication prevention. Substantial evidence supports the use of internet-based technologies for improving intervention efficiency. This study aimed to systematically evaluate the effectiveness of an internet-based health examination model within primary care settings. METHODS: We conducted a 6-year community demonstration trial at the Dashi Street Community Public Health Service Center in Panyu District, Guangzhou, China. The study focused on focus populations, defined as individuals aged over 65 years, or those aged 35 years and above with either hypertension or type 2 diabetes. Starting in 2021, an internet-based health examination model was introduced for these groups. The study utilized the Structure-Process-Outcome (SPO) framework for systematic evaluation and adopted a quasi-experimental design to assess model effectiveness. RESULTS: The internet-based model demonstrated superior performance in structural and process dimensions, facilitating expanded health examination coverage with reduced staffing needs. Outcome analyses included data from 47,380 participants over six years (2018–2023): 21,157 under the traditional model (2018–2020) and 26,223 under the internet-based model (2021–2023). Generalized estimating equation (GEE) analysis showed that the internet-based model achieved significantly higher participation rates than the traditional model among focus populations [OR = 1.148, 95% CI: 1.101–1.197, P < 0.001]. Interrupted time series (ITS) analysis revealed an immediate increase in participation numbers following implementation [β = 192.56, 95% CI: 68.17, 316.96, P = 0.004], with no significant change in trend [β = 1.28, 95% CI: -12.82, 15.37, P = 0.852]. The internet-based model was also more cost-effective, with a mean cost per participant of ¥395.95 compared to ¥1,213.74 for the traditional model. Incremental cost-effectiveness ratios (ICERs) indicated cost savings per additional percentage point in participation rate: ¥–130,685.51 for adults ≥ 65 years, ¥–78,974.64 for hypertensive patients, and ¥–98,100.68 for type 2 diabetes patients. Examination duration was significantly shorter across all age groups with the internet-based model (all P < 0.001). Satisfaction levels (χ²=98.169, P < 0.001) and willingness to reuse services (χ²=36.974, P < 0.001) were also significantly higher in the internet-based group. CONCLUSIONS: For community-based focus populations, the internet-based health examination model demonstrated superior effectiveness in expanding coverage rates and was highly cost-effective compared to the traditional model. The findings support its potential for broader adoption in community health service centers, though implementation should consider local infrastructure and population characteristics.