primary care and avoidable hospitalization for diabetes
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Primary care and avoidable hospitalization for diabetes. Michael van den Berg Tessa van Loenen ([email protected]). The QUALICOPC project. General objective: To evaluate European primary care systems on quality, equity and costs - PowerPoint PPT PresentationTRANSCRIPT
Primary careand avoidable hospitalization for diabetes
Michael van den BergTessa van Loenen([email protected])
PC and Diabetes hospitalization | 09/09/2013
The QUALICOPC project
General objective: To evaluate European primary care systems on quality, equity and costs
Hypothesis:The way primary care is organized in a country is related to:
– How patients perceive the quality of pc– How providers deliver services– Overall health care outcomes (quality,
equity and costs)
PC and Diabetes hospitalization | 09/09/2013
The QUALICOPC project
Three Surveys- Among random samples of GPs
(around 220/country)
- Among patients visiting GP practices (10/practice)
- Among the field workers visiting GP practices (1/practice)
PC and Diabetes hospitalization | 09/09/2013
More information on: www.qualicopc.eu
Workpackage: Avoidable hospital admissions● Admission rates for ambulatory care sensitive conditions (ACSC)
– Indicator for primary health care performance, quality and access
● Which admissions can be avoided?– Acute conditions– Adverse drugs events– Chronic conditions Diabetes
● Objective: − Gain insight in relationships at country level between the structure and
organization of primary care and the prevalence of avoidable hospitalizations for Diabetes
PC and Diabetes hospitalization | 09/09/2013
Avoidable hospitalization:
PC and Diabetes hospitalization | 09/09/2013
Source: OECD Health data 2011
Austr
alia
Czech
repub
licPol
and
Austr
ia
German
y
New Zea
land
Latvia
Irelan
dMalt
a
Slove
nia
Denmark
Portug
al
Finlan
d
Netherl
ands
Swede
nIta
lySpa
in
Cana
da
Switze
rland
Norway
Icelan
d UK0
50
100
150
200
250
Diabetes long-term complication admission rateAge-sex standardized per 100.000 population
Avoidable hospitalization:
PC and Diabetes hospitalization | 09/09/2013
Austria
Hungary
Finlan
d
Swed
enPolan
d
Denmark
German
y
Norway
Slove
niaMalt
aIta
ly
Irelan
d
Czech re
public UKIce
land
Switze
rland
Latvia
Portuga
l
Canad
a
New Ze
aland
Australia
Spain
0
20406080
100120140160180200
Uncontrolled diabetesAge-sex standardized per 100.000 population
Avoidable hospital admissions and Primary care
● 3 Primary care organizational characteristics: – Access
› Financial or geographical access, ooh-care, waiting times
– Position primary care in health care system› Central or marginal role, medical record keeping, referrals, continuity
– Task profile› Broad or small task profiles
Hypothesis: Systems with easily accessible, central primary care with broad task profile have lower prevalence of avoidable hospitalizationPC and Diabetes hospitalization | 09/09/2013
Methods Data sources: - QUALICOPC data: GP questionnaire and Patient questionnaire- OECD Health care quality indicators
Analyses:- Analyses are based on 22 countries
- Ecometrics for scale construction at country level- Simple regressions- multivariable regression with one control variable: Diabetes
prevalence
PC and Diabetes hospitalization | 09/09/2013
Results: Taskprofile
PC and Diabetes hospitalization | 09/09/2013
Correlation Treatment and follow up
Activities Prevention Chronic care management
Disease management program
Long term complications
-0.337 -0.453** 0.132 0.158 0.236
Uncontrolled diabetes
-0.019 -0.130 0.044 0.039 -0.058
* p-value <0.1** p-value <0.05
Results: Taskprofile
PC and Diabetes hospitalization | 09/09/2013
0 1 2 3 40
50
100
150
200
250
Austria
Czech republic
DenmarkFinland
Germany
Iceland
Ireland
Italy
Latvia
MaltaNetherlands
Norway
Poland
PortugalSlovenia
SpainSweden
SwitzerlandUK
Australia
Canada
Activities
Diab
etes
long
-ter
m co
mpl
icatio
n ad
miss
ion
Results: Access
PC and Diabetes hospitalization | 09/09/2013
Correlation Out-of-Office hours
Disadvantaged people
Patient perceived access
No restrictions to new patients
Long term complications
-0.332 0.319 0.355* 0.379*
Uncontrolled diabetes
0.108 0.019 0.011 0.378
* p-value <0.1** p-value <0.05
Results: Access
PC and Diabetes hospitalization | 09/09/2013
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.80
50
100
150
200
250
Austria
Czech republic
DenmarkFinland
Germany
Iceland
Ireland
Italy
Latvia
Malta
Netherlands
Norway
Poland
Portugal Slovenia
SpainSweden
SwitzerlandUK
Australia
Canada
Patient perceived access
Diab
etes
long
term
com
plca
tion
adm
issio
n ra
te
Results: Position of PC
PC and Diabetes hospitalization | 09/09/2013
Correlation Collaboration between GP and other professionals
Continuity of care
Long term complications -0.233 -0.051
Uncontrolled diabetes -0.050 -0.266
Discussion
● Based on these preliminary data:– Differences between countries can partly be explained by organization and
structural differences – Diabetes prevalence : what other factors to take into account?
● Future steps: Include more countries– Update OECD data on avoidable hospitalization– Include more QUALICOPC countries
PC and Diabetes hospitalization | 09/09/2013
PC and Diabetes hospitalization | 09/09/2013
PC and Diabetes hospitalization | 09/09/2013
Portuga
l
Cypru
s
Poland
New Ze
aland
Canad
aTu
rkey
Latvia
Lithuan
ia
Romania
Slove
nia
Estonia
Malta
Bulgaria
Australi
a
Austria
Spain
Hungary
Finlan
d
Switze
rland
Slova
kia
Denmark
France
German
y
Czech re
public
Netherl
ands
Irelan
d UKIta
lyGree
ce
Belgium
Norway
Luxemourg
Swed
enIce
land
0
2
4
6
8
10
12
Diabetes prevalence (%)
Source: IDF 2012
Results: Position of PC
PC and Diabetes hospitalization | 09/09/2013
0 0.5 1 1.5 2 2.5 30
20
40
60
80
100
120
140
160
180
200 Austria
Czech rep.
DenmarkFinland
Germany
Hungary
IcelandIreland
Italy
Latvia
Malta Norway
Denmark
Portugal
Slovenia
Spain
Sweden
Switzerland
UK
AustraliaCanada
Continuity of care
Unco
ntro
lled
diab
etes
adm
issio
n ra
te