Abstract
BackgroundThe regional integrated health care model “Healthy Kinzigtal” started in 2006 with the goal of optimizing health care and economic efficiency. The INTEGRAL project aimed at evaluating the effect of this model on the quality of care over the first 10 years.MethodsThis methodological protocol supplements the study protocol and the main publication of the project. Comparing quality indicators based on claims data between the intervention region and 13 structurally similar control regions constitutes the basic scientific approach. Methodological key issues in performing such a comparison are identified and solutions are presented.ResultsA key step in the analysis is the assessment of a potential trend in prevalence for a single quality indicator over time in the intervention region compared to the corresponding trends in the control regions. This step has to take into account that there may be a common - not necessarily linear - trend in the indicator over time and that trends can also appear by chance. Conceptual and statistical approaches were developed to handle this key step and to assess in addition the overall evidence for an intervention effect across all indicators. The methodology can be extended in several directions of interest.ConclusionsWe believe that our approach can handle the major statistical challenges: population differences are addressed by standardization; we offer transparency with respect to the derivation of the key figures; global time trends and structural changes do not invalidate the analyses; the regional variation in time trends is taken into account. Overall, the project demanded substantial efforts to ensure adequateness, validity and transparency.
Highlights
The regional integrated health care model “Healthy Kinzigtal” started in 2006 with the goal of optimizing health care and economic efficiency
In order to facilitate the understanding of the background of these key figures, we suggest a two-dimensional visualization of all trend estimates and the estimated mean and standard deviation of the true trends in the control regions
Analysing an indicator with a global trend It is well known that the use of statins in patients with coronary heart disease (CHD) has increased during the study period
Summary
The regional integrated health care model “Healthy Kinzigtal” started in 2006 with the goal of optimizing health care and economic efficiency. The INTEGRAL project aimed at evaluating the effect of this model on the quality of care over the first 10 years. The model addresses the full spectrum of morbidities and health issues for a population defined by a residential area (with the only exception of dental care). It is based on a contract among a regional physicians’ network, a management and holding company specialised in integrated care, and the Allgemeine Ortskrankenkasse Baden-Württemberg (AOK-BW), the largest statutory health insurance fund in the federal state of Baden-Württemberg (BW). (For further details we refer to the study protocol [1] and the main project publication [2].) From an economic perspective the contract was rather successful, as cost savings were achieved. The aim of the INTEGRAL project was to conduct such an evaluation
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