Chinese Healthcare System

Laboratory monitoring coverage was incomplete: only approximately 50% of patients with a baseline eGFR or serum potassium measurement had at least one repeat measurement during follow-up, with UACR coverage consistently low. Despite national guidance in 2015 and Tianjin's own 2017 plan both aiming to shift chronic disease management toward primary care, EHR data suggest this transition had not yet occurred during the study period. The predominance of specialist over GP visits reflects a structural feature of Chinese healthcare during the study period, not individual patient behaviour. Over 96% of patients in both cohorts had at least one specialist visit during baseline, while only approximately 25% had any GP visit — a pattern that persisted into follow-up.