Modesta Visca

1. 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

2. Increasing diffusion of chronic disease • Crucial role of Medical Primary Care • Performance Measurements • Huge amount availability of administrative data

3. 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

4. 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

5. 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

6. 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

8. Chronic disease patients

9. 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%

10. Solo practice Base group practice Network group practice Advanced group practice Average number of recomandations followed by each GP (max 4):Diabetes

11. Solo practice Base group practice Network group practice Advanced group practice Average number of recomandations followed by each GP (max 3): Ischemic heart disease

12. Solo practice Base group practice Network group practice Advanced group practice Average number of recomandations followed by each GP (max 4): Congestive heart failure

13. 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).

14. Multilevel analysis: GP level District level

15. 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

16. Thank you for your attention VALORE PROJECT : Research Units