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Gesundes Kinzigtal Integrated Care: interim results of the external evaluation Achim Siegel , Ingrid Köster, Ingrid Schubert, Lars Hölzel, Martin Härter, Ulrich Stößel. Baden-Württemberg. and the Kinzigtal region. Research questions.

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slide1

Gesundes Kinzigtal Integrated Care:

interim results of the external evaluation

Achim Siegel, Ingrid Köster, Ingrid Schubert,

Lars Hölzel, Martin Härter, Ulrich Stößel

slide2

Baden-Württemberg

and the

Kinzigtal region

research questions
Research questions

Does an integrated care system of the Kinzigtal type lead to a…

higher degree of shared decison-making?

higher patient satisfaction?

better health of insurants (compared to usual care)?

reduction of over-, under- and mis-use of care (compared to usual care)?

growing satisfaction of physicians and other providers?

more intensive cooperation among providers?

higher global efficiency (without a decrease in quality)?

SDM study

OUM study

sdm study target variables
SDM study: target variables

- participation preference

- perceived participation

- decisional conflict

- satisfaction with primary care

- quality of life

...extracted from questionnaire data

sdm study design
SDM study: design

other Kinzigtal insurants

(B)

insurants of

control region

(C)

GKIC members

(A)

T0: 2007

therapy goal agreements

SDM training of GPs

(B)

T1: 2008

(A)

(C)

therapy goal agreements,

SDM trainingof GPs

(B)

T2: 2009

(A)

(C)

slide6
no significant intervention effects

reasons?

SDM training too short?

training not accepted by GPs?

increasing expectations in intervention cohort?

patients not interested in participation?

adverse effects of IC on participation?

oum study target variables
OUM study: target variables

utilisation figures

- e.g. hospitalisation prevalence

- e.g. prevalence of care-dependency (levels I-III)

prevalence & incidence of diseases

indicators of health care quality

generic („global“)

disease-specific

oum study method
OUM study: method

- quasi-experimental study

- intervention group: insurants of Kinzigtal region

- controls: 20% sample of insurants outside Kinzigtal region

- claims data

- baseline year: 2004

- follow-up: 2005-2011

aok insurants in oum study
AOK insurants in OUM study

standardised with respect to

age and sex (and degree of morbidity)

slide11

Insurants with long-term prescription

of benzodiazepines (>20 DDD / year)

proportion in %

4,0

4,0

3,9

3,8

3,9

**

controls BW standardised

according to age and sex of Kinzigtal insurants per year

slide12

Insurants with long-term prescription

of benzodiazepines (>20 DDD / year)

significant difference

(p < 0.05)

proportion in %

4,0

4,0

3,9

3,8

3,9

**

controls BW standardised

according to age and sex of Kinzigtal insurants per year

2,5

2,5

2,5

2,5

2,4

slide13

Insurants dependent on care (care level I-III)

proportion in %

6,0

5,8

5,6

5,7

5,6

**

controls BW standardised

according to age and gender of Kinzigtal insurants in a given year

slide14

Insurants dependent on care (care level I-III)

proportion in %

6,0

5,8

5,8

5,6

5,7

5,6

**

controls BW standardised

according to age and gender of Kinzigtal insurants in a given year

slide15

Insurants dependent on care (care level I-III)

significant difference

(p < 0.05)

proportion in %

6,0

5,8

n.s.

5,8

5,6

5,6

5,7

5,6

**

controls BW standardised

according to age and gender of Kinzigtal insurants in a given year

5,5

5,5

5,4

slide17

Insurants with CHD*

  • any insurant with
  • EITHER a hospital‘s main dis-
  • charge diagnosis code in
  • range I20-I25 or Z95.1 or Z95.2
  • OR the same diagnosis codes
  • received in out-patient treatment
  • in at least two quarters
  • OR with one of the above diagno-
  • ses received in out-patient
  • treatment AND at least one CHD-
  • specific drug prescription

*

proportion in %

6,6

6,7

6,7

6,8

7,1

**

controls BW standardised

with respect to age and gender

structure of the Kinzigtal

population of a given year

5,6

5,8

5,7

5,5

5,5

slide18

AOK insurants with CHD*, thereof proportion with

at least one consultation of a cardiologist per year

*

definition CHD cf. above

proportion in %

32,0

31,1

30,1

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

slide19

AOK insurants with CHD*, thereof proportion with

at least one consultation of a cardiologist per year

*

definition CHD cf. above

proportion in %

32,1

32,0

31,1

30,1

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

slide20

AOK insurants with CHD*, thereof proportion with

at least one consultation of a cardiologist per year

*

definition CHD cf. above

significant difference

(p < 0.05)

35,8

proportion in %

32,7

32,1

n.s.

32,0

31,1

30,1

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

slide21

Prescription prevalence of anti-platelet drugs

among insurants with CHD*

*

definition CHD cf. above

41,7

40,8

40,7

38,0

38,5

proportion in %

32,8

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

slide22

Prescription prevalence of anti-platelet drugs

among insurants with CHD*

*

definition CHD cf. above

41,7

40,8

40,7

n.s.

38,0

38,5

40,8

n.s.

39,3

38,9

proportion in %

36,3

32,8

Cave: high proportion of self-

medication in both populations!

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

slide23

Beta-blocker prescription prevalence

among insurants with CHD*

*

definition CHD cf. above

proportion in %

66,3

64,3

63,0

**

controls BW standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

60,5

57,1

slide24

Beta-blocker prescription prevalence

among insurants with CHD*

*

definition CHD cf. above

significant difference

(p < 0.05)

69,6

67,4

proportion in %

66,1

63,3

66,3

60,5

64,3

63,0

**

controls BW“ standardised

with respect to age and sex

of the given year and to morbidity

of the preceding year

60,5

57,1

slide25

Statine prescription prevalence

among insurants with CHD*

*

definition CHD cf. above

54,2

50,4

47,2

proportion in %

43,1

39,9

**

controls BW standardised

with respect to age and sex of

the given year, and to morbidity

in the preceding year

slide26

Statine prescription prevalence

among insurants with CHD*

*

definition CHD cf. above

54,2

50,4

47,2

proportion in %

43,1

39,9

**

controls BW standardised

with respect to age and sex of

the given year, and to morbidity

in the preceding year

36,9

slide27

Statine prescription prevalence

among insurants with CHD*

*

definition CHD cf. above

54,2

significant difference

(p < 0.05)

n.s.

50,4

47,2

52,0

proportion in %

43,1

48,4

39,9

44,3

**

controls BW standardised

with respect to age and sex of

the given year, and to morbidity

in the preceding year

38,7

36,9

oum study preliminary results 2004 08
OUM study: preliminary results 2004-08
  • administrative prevalence:
  • generally in Kinzigtal region than in BW
  • health care quality indicators:
  • generally more favourable values / developments in Kinzigtal region
  • additional years (2009ff) should be observed
slide29

www.ekiv.org

EKIV Newsletter

available in English, too!

slide30

We are indebted to

Gesundes Kinzigtal Ltd.

AOK Baden-Württemberg

LKK Baden-Württemberg

for good cooperation and support

slide31

GKIC‘s external evaluation

OUM:

analysis of over-,

under- and mis-use of

health care

SDM:

shared decision-making & patient satisfaction

EKIV:

coordination centre,

Freiburg University

GKIC

evaluation team

AGil:

active health promo-tion in the elderly

survey of

GKIC‘s partner

providers

slide32

GKIC‘s external evaluation

OUM:

analysis of over-,

under- and mis-use of

health care

SDM:

shared decision-making & patient satisfaction

EKIV:

coordination centre,

Freiburg University

GKIC

evaluation team

AGil:

active health promo-tion in the elderly

survey of

GKIC‘s partner

providers

slide33

Bone fracture prevalence among

insurants with osteoporosis* in the preceding year

*

def. cf. above

30,0

28,9

27,9

27,1

proportion in %

„sample BW“ standardised

according to age and sex of

the given year and to morbidity

of the preceding year

**

slide34

Bone fracture prevalence among

insurants with osteoporosis* in the preceding year

*

def. cf. above

30,0

28,9

27,9

27,1

proportion in %

23,7

22,0

„sample BW“ standardised

according to age and sex

of the given year and to morbidity

of the preceding year

**

slide35

Bone fracture prevalence among

insurants with osteoporosis* in the preceding year

*

def. cf. above

significant difference

(p < 0.05)

30,0

28,9

27,9

27,1

proportion in %

23,7

22,7

22,4

22,0

„sample BW“ standardised

according to age and sex

of the given year and to morbidity

of the preceding year

**