Leader: Gianluca Fiorentini (UNIBO); Other collaborator(s):
Task 2 will rely on the availability of the integrated platform developed in Task1 to provide an in-depth analysis of the role of general practitioners - as agents in a multi-principal relationship with their patients and the local health authorities – in supporting the implementation of prevention programs. The main aim of the Task is to provide a comparison of educational interventions, monetary incentives, and alternative organizational solutions in affecting the compliance of general practitioners with broad clinical pathways and specific clinical guidelines. The comparative effectiveness of various supply-side interventions will be measured in terms of improvement in the adherence to guidelines and in long-run health outcomes.
Brief description of the activities and of the intermediate results
From November ‘23 to March ‘24, several meetings were organized involving members of the Bologna unit and the LHA of Romagna to develop various dimensions of the project in detail. As for the policy evaluation of supply-side interventions, the task 2 group has been working to assess the impact - in terms of guideline adherence and of health outcomes - of two main organizational innovations to manage an ageing and multimorbid population. The first main innovation is the introduction of Family and Community Nurses in some small areas of the LHA of Romagna. On this, the Bologna unit worked together with the LHA personnel to define an empirical strategy and a framework for the analysis. On the basis of such strategy, some preliminary results were discussed, and the first part of a descriptive report is due for June 2024. A second large scale intervention whose impact on guidelines’ compliance and health outcomes is to be evaluated is the so called “Nursing management” of chronic patients. On this project, the Bologna unit delivered a final version of the protocol and submitted to the LHA a set of variables of interest for the analysis. The LHA is proceeding with the download of the data and with the operations of data linkage. Data protection issues were discussed to organize an anonymized data transfer. Meanwhile, to assess the impact of monetary incentives, the Bologna unit analyzed the GP agreements signed in Romagna LHA from 2015-2023 and the different economic incentives addressed to GPs joining an integrated chronic disease management program. The Bologna unit also submitted an abstract to the EUHEA conference planned in Vienna in July. A detailed analysis of DM 77/22 new organizational settings was conducted and resulted in a working paper to be published in “Rivista di Politica Economica”.
Main policy, industrial and scientific implications
The process of drafting the protocols and the steps required to agree with the LHA on the procedures to obtain the datasets needed to evaluate the performances of various policy innovations for chronic disease management highlighted the need of a review of the privacy regulation for planning and policy evaluation purposes. This is especially true when the analysis focusses on primary prevention policies where stratification tools are recommended which target individuals who might never been contacted by the national health service. The preliminary stages of the empirical work on the data do not allow to define so far significant policy implications based on a rigorous analysis. However, the qualitative analysis of the agreements between the LHA and the associations of GPs and of the organizational and economic innovations recently adopted to team up between LHA personnel and GPs in the management of chronic patients points to enduring problems in finding more collaborative solutions. The central role of an heterogeneous array of monetary incentives for GPs to promote guideline compliance, is also seen as a point on which the empirical analysis on the LHA of Romagna should shed more light as the scientific literature on other countries provides contrasting evidence.
Brief description of the activities and of the intermediate results
- Meetings with the LHA of Romagna to define dataset key linkage and data format.
- Setup of a secure UNIBO cloud environment for data sharing among UNIBO researchers.
- Analysis of the impact of the first years of Nursing Outpatient Clinics (NOCs) introduction, using data related to diabetes patients in Romagna LHA from 2010-2016.
- Presentation of preliminary results on the impact of the first years of NOCs introduction in Romagna LHA, at the UNIBO Age-IT meeting held in Bologna on May 10th, 2024.
- Participation in the AGE-IT General Meeting held in Venice, May 20th-22nd, 2024 https://ageit.eu/wp/convegno-venezia-2024/.
- Submission to the Italian Health Economics Association (AIES) annual conference of the paper: “Interprofessional collaboration: the role of primary care physicians and nurses in a successful chronic disease management program”.
Brief description of the activities and of the intermediate results
- Writing of the first draft of the work presented in Vienna.
- Presentation at the European Health Economics Association (EUHEA) conference of results on the impact of the first years of NOCs introduction, with the work titled “The Impact of Nursing Outpatient Clinics on Chronic Disease Management.” Program available at the link: https://euhea.eu/welcome_conference_2024.html.
- Check of the feasibility of linking different datasets.
- Empirical analysis of the role of macro-institutional characteristics of various EU health systems (vertical integration and degree of competition) in dealing with a growing number of chronic patients using data from Share.
Brief description of the activities and of the intermediate results
- Meetings with Romagna LHA to discuss and update ongoing projects.
- Refining of the working paper “The impact of Nursing Outpatient Clinics on diabetes care: are they a promising avenue to improve patient adherence?”
- Presentation at the Italian Health Economics Association (AIES) conference of results on the impact of the first years of NOCs introduction, with the work titled “The impact of Nursing Outpatient Clinics on diabetes care: are they a promising avenue to improve patient adherence?.” Program available at the link: https://www.aiesweb.it/wp-content/uploads/2024/12/programma-AIES-definitivo-30.11.pdf
- Preparatory work to create a unified dataset for diabetic patients from 2017 to 2023, including comprehensive information on health services consumption (such as hospitalization and access to ED rooms), diagnoses, and organizational healthcare settings.
- Preparatory work on creating and collecting comprehensive information about GPs, including the patients registered on their lists and the respective periods, the organizational forms adopted, their primary unit of affiliation, the incentives provided, and their adherence to integrated care programs.
- Participation of a Unibo and Romagna LHA team in ACG training to enable the prompt application of advanced stratification tools and techniques to improve patient enrollment in chronicity programs and conduct impact analysis.
Brief description of the activities and of the intermediate results
- Meeting with Romagna LHA to discuss new proposals and update on ongoing projects.
- Meetings to discuss data integration aimed to create a highly informative dataset.
- Submission of the paper “The impact of Nursing Outpatient Clinics on diabetes care: are they a promising avenue to improve patient adherence?”
- Completion of a comprehensive dataset that collects thorough information on primary care physicians, including the patients registered on their lists and the corresponding time periods, the organizational forms adopted, their primary unit of affiliation, the incentives provided, and their participation in integrated care programs.
- Nearing completion of the unified dataset for diabetic patients from 2017 to 2023, including comprehensive information on health services consumption (such as hospitalization and access to ED rooms), diagnoses, M-CDS, insulin consumption, and organizational healthcare settings.
- WP meeting to discuss the policy brief deliverable, followed by the preparation of a joint abstract.
- Presentation at the EUHA conference, June 30th - July 3rd, 2024: “The Impact of Nursing Outpatient Clinics on Chronic Disease Management,” by Gianluca Fiorentini, Marta Giachello, Cristina Ugolini, and Rossella Verzulli. https://euhea.eu/session_details_conference_2024.html#id=889
- Paper published in Rivista di Politica Economica: “La Medicina di Famiglia nel Riassetto dell’Assistenza Territoriale,” by Marta Giachello and Cristina Ugolini, 2024, 1, pp. 67–90. Available at: https://www.confindustria.it/home/centro-studi/rivista-di-politica-economica/dettaglio?doc=RPE_la_salute_dei_sistemi_sanitari_2024_1
- Presentation at the AIES conference, December 9th- 10th, 2024: “The impact of Nursing Outpatient Clinics on diabetes care: are they a promising avenue to improve patient adherence?” by Marta Giachello, Cristina Ugolini, and Rossella Verzulli. https://www.aiesweb.it/xxix-national-conference/
- Submission of paper entitled “The impact of Nursing Outpatient Clinics on diabetes care: are they a promising avenue to improve patient adherence?”
- Submission of a paper entitled “Understanding healthcare systems responses to the rise of multimorbidity and its impact on health outcomes in Europe”
- Submission of a paper entitled “Tough versus Soft Regulations to Promote Generic Medications among Italian Physicians”