slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Modesta Visca PowerPoint Presentation
Download Presentation
Modesta Visca

Loading in 2 Seconds...

play fullscreen
1 / 16

Modesta Visca - PowerPoint PPT Presentation


  • 92 Views
  • Uploaded on

EFPC 4th biannual conference in Gothenburg "Crossing Borders in Primary Care". Performance variation in managing chronic disease by Italian Family Medicine. A population study using health administrative data: The VALORE study. Gotenborg, 4 September 2012. Modesta Visca.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Modesta Visca' - nerina


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

EFPC 4th biannual conference in Gothenburg "Crossing Borders in Primary Care"

Performance variation in managing chronic disease by Italian Family Medicine. A population study using health administrative data: The VALORE study

Gotenborg, 4 September 2012

Modesta Visca

slide2

Increasing diffusion of chronic disease

  • Crucial role of Medical Primary Care
  • Performance Measurements
  • Huge amount availability of administrative data
slide3

Definition of a methodology in order to :

Evaluate the impact of specific organizational aspect of Family Medicine (group practice vs solo practice) regarding chronic disease management process indicators in six Italian regions.

Objective

slide4

Study design

3 observational longitudinal retrospective studies + ad hoc survey

  • The observation unit was GP: the set of GPs at 1°January 2008 having at least 4 patients detected as affected by the disease; having more than 300 patient on their list
  • GPs adherence or not to a “traditional” group practice in the previous year

Analysis

  • Descriptive analyses
  • Frequency and ditribution
  • Average value and standard deviation
  • GPs description oftheir practice typology
  • Statistical analyses:
  • Multilevel model :
    • Level I unit : GPs
    • Level II unit : Groups/Health Districts

Administrative data

slide5

Algorithms for case definition

La banca dati MaCro delle malattie croniche in Toscana. Pubblicazione ARS \Toscana numero 48. Dicembre 2009.www.ars.toscana.it/c/document_library/get_file?uuid=65f497a2-bd99-4cc6-832bab37ebd72dfb&groupId=11864

slide6
Outcome variable: the average score of GP’s patients, the score of the patient as sum of the standards that were met during one year follow up (2008)

Misures of process outcome

unadjusted prevalences n chronic disease patients x 1 000 patients
Unadjusted Prevalences(N. chronic disease patients x 1.000 patients)

4.9%

1.4%

Diabetes Prevalence

Congestive heart failure Prevalence

Ischemic heart disease Prevalence

4.1%

slide10

Solo practice

Base group practice

Network group practice

Advanced group practice

Average number of recomandations followed by each GP (max 4):Diabetes

slide11

Solo practice

Base group practice

Network group practice

Advanced group practice

Average number of recomandations followed by each GP (max 3): Ischemic heart disease

slide12

Solo practice

Base group practice

Network group practice

Advanced group practice

Average number of recomandations followed by each GP (max 4): Congestive heart failure

other variables
Other variables

Characteristics of the GP:GPs age and gender (indicator variable for female);

Profile of assisted population: number, proportion aged 75+, average Charlson index;

Profile of patients with the chronic condition under analysis:proportion aged 85+, proportion bearing the condition for 4+ years; average Charlons Index

Socio-demographic:average population density (inhab/km2) of the municipality of residence of the patients with the chronic condition under analysis;

Health district policy:indicator variable of financial incentives for the adherence to diabetes management recommendations (only for diabetes).

slide14

Multilevel analysis:

GP

level

District level

slide15

Conclusions

  • In the selected Health Districts there appears to be no significant difference between the impact of traditional group practice and solo practice on chronic disease management
  • The reorganization of primary care system required is wider and involves GPs who still lie at the core of the system, togheter with other professional forces, such as specialist, nurses, social worker, etc
  • Success Prerequisites are
  • Sustainable evidence-baced innovation and planning at local level
  • Committment, from regional policy maker, local administrators and professionals
  • Reproducibility of methodology for information collecting and standards for process measurement
  • Motivational Mechanisms, since the economic constraints in terms di research and education (on the base of the change management in Primary Health Care principles).

15

slide16

Thank you for your attention

VALORE PROJECT : Research Units