Abstract
BackgroundIn an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+.Methods/DesignThe study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results.ConclusionsThis study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes.Trial registrationNTR6629 (Data registered: 25-08-2017) (registered retrospectively).
Highlights
In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed
This study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes
The practice-based study focuses on a cardiology Primary Care Plus (PC+) centre. In this pioneer site PC+ implies substitution of specialist care in the hospital setting with specialist care in the primary care setting and it is designed for patients with non-acute and lowcomplexity related health complaints
Summary
In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. The health-care system should focus on high-value health care This implies that initiatives should focus on simultaneously pursuing the three aims: improving the health of the population, improving the quality of care (as experienced by patients) and reducing the increase of healthcare costs. A concrete action in line with these strategies includes that the Ministry of Health appointed nine regional initiatives as ‘pioneer sites’ These pioneer sites are able to experiment with (new) interventions which are focused on the regional population. An unambiguous and widely accepted definition of PM is lacking, PM initiatives focus on addressing health needs at all points along the continuum of health and well-being for a specified population by integrating services across health care, prevention, social care and welfare [13] These pioneer sites follow the abovementioned ‘Triple Aim’ principle [6, 7]. All pioneer sites will be monitored over the coming years
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