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Strong and sustainable primary healthcare is associated with a lower risk of hospitalization in high risk patients.
Sawicki, Olga A; Mueller, Angelina; Klaaßen-Mielke, Renate; Glushan, Anastasiya; Gerlach, Ferdinand M; Beyer, Martin; Wensing, Michel; Karimova, Kateryna.
Afiliación
  • Sawicki OA; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany. sawicki@allgemeinmedizin.uni-frankfurt.de.
  • Mueller A; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany.
  • Klaaßen-Mielke R; Institute of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44789, Bochum, Germany.
  • Glushan A; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany.
  • Gerlach FM; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany.
  • Beyer M; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany.
  • Wensing M; Department of General Practice and Health Services Research and Implementation Science, 69129, Heidelberg, Germany.
  • Karimova K; Institute of General Practice, Goethe University, 60590, Frankfurt, Germany.
Sci Rep ; 11(1): 4349, 2021 02 23.
Article en En | MEDLINE | ID: mdl-33623130
In 2004, Germany introduced a program based on voluntary contracting to strengthen the role of general practice care in the healthcare system. Key components include structured management of chronic diseases, coordinated access to secondary care, data-driven quality improvement, computerized clinical decision-support, and capitation-based reimbursement. Our aim was to determine the long-term effects of this program on the risk of hospitalization of specific categories of high-risk patients. Based on insurance claims data, we conducted a longitudinal observational study from 2011 to 2018 in Baden-Wuerttemberg, Germany. Patients were assigned to one or more of four open cohorts (in 2011, elderly, n = 575,363; diabetes mellitus, n = 163,709; chronic heart failure, n = 82,513; coronary heart disease, n = 125,758). Adjusted for key patient characteristics, logistic regression models were used to compare the hospitalization risk of the enrolled patients (intervention group) with patients receiving usual primary care (control group). At the start of the study and throughout long-term follow-up, enrolled patients in the four cohorts had a lower risk of all-cause hospitalization and ambulatory, care-sensitive hospitalization. Among patients with chronic heart failure and coronary heart disease, the program was associated with significantly reduced risk of cardiovascular-related hospitalizations across the eight observed years. The effect of the program also increased over time. Over the longer term, the results indicate that strengthening primary care could be associated with a substantial reduction in hospital utilization among high-risk patients.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Enfermedad de la Arteria Coronaria / Diabetes Mellitus / Insuficiencia Cardíaca / Hospitalización Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Sci Rep Año: 2021 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Enfermedad de la Arteria Coronaria / Diabetes Mellitus / Insuficiencia Cardíaca / Hospitalización Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Sci Rep Año: 2021 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido