Abstract
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.
Highlights
In 2004, Germany introduced a program based on voluntary contracting to strengthen the role of general practice care in the healthcare system
The program consists of structured management of chronic diseases, continuous data-based quality improvement using computerized decision support for prescribing medication, and payment mainly by capitation per enrolled patient[9]
Patients enrolled in the primary care program had more comorbidities than non-enrolled patients, as measured using the Charlson index
Summary
In 2004, Germany introduced a program based on voluntary contracting to strengthen the role of general practice care in the healthcare system. 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 results indicate that strengthening primary care could be associated with a substantial reduction in hospital utilization among high-risk patients. The aim of this study was to assess the long-term effects of the primary care program on hospitalization risk among highrisk patients over a considerably longer follow-up of eight years. Since the impact of demographic change on healthcare systems is a pressing issue in all developed c ountries[18], it is widely recommended that the long-term effects of interventions in high-risk patients are studied before setting health policy
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