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Gesundes Kinzigtal Integrated Care: interim results of the external evaluation

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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Gesundes Kinzigtal Integrated Care: interim results of the external evaluation

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  1. Gesundes Kinzigtal Integrated Care: interim results of the external evaluation Achim Siegel, Ingrid Köster, Ingrid Schubert, Lars Hölzel, Martin Härter, Ulrich Stößel

  2. Baden-Württemberg and the Kinzigtal region

  3. 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

  4. SDM study: target variables - participation preference - perceived participation - decisional conflict - satisfaction with primary care - quality of life ...extracted from questionnaire data

  5. 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)

  6. 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?

  7. 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

  8. 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

  9. AOK insurants in OUM study standardised with respect to age and sex (and degree of morbidity)

  10. ‚Global‘ utilisation figures & quality indicators - AOK BW insurants -

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Disease-specific utilisation figures & quality indicators - e.g., coronary heart disease (CHD)

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. www.ekiv.org EKIV Newsletter available in English, too!

  30. We are indebted to Gesundes Kinzigtal Ltd. AOK Baden-Württemberg LKK Baden-Württemberg for good cooperation and support

  31. 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

  32. 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

  33. 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 **

  34. 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 **

  35. 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 **

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