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
Brief description of the activities and of the intermediate results
Brief description of the activities and of the intermediate results