The accelerating demographic aging in China has intensified the burden of chronic conditions, necessitating multidisciplinary frameworks for sustained health management and coordinated care delivery. Integrated long-term care systems are critical for chronic disease management in aging populations, yet inefficiencies and resource misallocation persist. This study evaluates chronic care efficiency and identifies driving pathways under integrated long-term care systems to inform resource optimization. Data Envelopment Analysis (DEA) assessed technical, scale, and comprehensive efficiency across 34 cases selected from five Chinese cities: Wuxi, Jiaozuo, Changsha, Chengdu, and Chongqing Municipality. Fuzzy-set Qualitative Comparative Analysis (fsQCA) examined conditional configurations (governance, financing, information, workforce, service, innovation). DEA revealed only 2 regions achieved optimal efficiency (θ=1), with others exhibiting significant resource slack (up to 40.04). fsQCA identified governance (consistency=0.907) and information-sharing (consistency=0.687) as core conditions for high-efficiency pathways, while financing gaps and service inaccessibility drove inefficiency. fsQCA identified four high-efficiency configurations characterized by synergistic interactions: “Governance * ~Financing * Information * ~Workforce * ~Service” (consistency=0.968), “Governance * Information * ~Workforce * ~Service * ~Innovation” (consistency=0.829), “Governance * ~Financing * Information * Workforce * Innovation” (consistency=1.000) and “Governance * Financing * Information * Service * ~Innovation” (consistency=0.982). Six fragmented pathways explained efficiency divergence. Robustness tests (consistency threshold raised from 0.80 to 0.85) confirmed stability, with high-efficiency models achieving overall consistency of 0.978 (coverage reduced to 0.510). Cross-sector governance and interoperable health information systems are pivotal for optimizing chronic care. The DEA-fsQCA approach offers actionable insights for tailored strategies in aging societies.

Authors:
Rong Chen, Peking Union Medical College, China
Fang Wang, Peking Union Medical College, China
Jun Zhao, Chinese Academy of Medical Sciences, China
Siqi Liu, Chinese Academy of Medical Sciences, China

About the Presenter(s)
Rong Chen is a MPH Candidate of Institute of Medical Information and Library, Chinese Academy of Medical Sciences & Peking Union Medical College, China.

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