Abstract
IntroductionThe growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking.AimTo outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study.MethodsPerson-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken.AnalysisThe index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective.ConclusionCompletion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.
Highlights
The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care
In this paper we describe the protocol of the study ‘Evaluation of Enhanced Models of Primary Care in the Management of Stroke and Other Chronic Disease’ (PRECISE), a large scale data linkage project designed to address this knowledge gap
The cohort will be derived from the Australian Stroke Clinical Registry (AuSCR) and will include all registrants aged 18 years and over who were admitted to participating hospitals in Victoria and Queensland (n=42 hospitals) between 2012 and 2016
Summary
The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. In developed countries the contribution of Disability Adjusted Life Years (DALYs) due to stroke have been increasing proportionally to other diseases with concomitant burdens on healthcare systems [1] as stroke rarely occurs in isolation. Stroke is associated with considerable long-term costs from ongoing disability and associated comorbidity [4, 5]. Because of these complexities, models of care best suited to addressing patients’ ongoing care needs will vary. Regardless, all require some form of comprehensive long-term healthcare management
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