Leader: Luke Connelly (UNIBO); Other collaborator(s):
Task 3 will also rely on the availability of the integrated platform developed in Task1 to analyse the specific problems arising in the management of chronic care programs for multimorbid patients where different specialists may be given the leadership and/or where more than one program is simultaneously implemented. The main aim of the Task is to provide guidance to the policy maker on how to regulate the interaction between specialist practitioners and between them and the general practitioners to avoid discontinuities of care and under/over provision of care. Special attention will be devoted to the specific role of the new organizational settings in primary and intermediate care to better align the incentives of professionals.
Brief description of the activities and of the intermediate results
During the period November ‘23 to March ’24 the group involved in task 3 has been working on a panel dataset to examine the behaviour of clinicians involved in a chronic disease management program designed to improve the quality of care and to slow down the progression of chronic kidney disease. The panel dataset made use of eight years of quarterly data on the population of chronic kidney disease patients in the EmiliaRomagna region. The empirical analysis was driven by a theoretical model in which medical practitioners are conceived of as “double agents” who respond to the demands of two principals: their patient and the third-party payer (in this case the regional authority). Exploiting detailed information on specialist visits and the concentration of general practitioners (GPs), as well as disease severity, we investigated how various specialists and especially nephrologists and cardiologists comply with the guidelines of the chronic disease management program, as may be predicted by the dual-agency model. We made use of both multipletreatment (staggered in time) differences-in-differences and panel fixed-effects linear probability models. The preliminary evidence shows that there might be evidence of strategic behavior by some specialists, as well as by some GPs. We also produce some evidence that specialists who practice in facilities that are closely controlled by the Local Health Authorities (LHAs) exhibit referral practices that are more closely related to the guidelines for chronic disease management program as issued by the regional authorities.
Main policy, industrial and scientific implications
Chronic disease management programs are based on guidelines that are implemented by physicians who interact between themselves—and with the patients—in a closely linked network of relationships. This includes not only primary care professionals such as GPs, but also specialists from various disciplines, because most patients who are enrolled in such chronic disease management programs are multimorbid. These practitioners act in an agent-multiple principal setting with conflicting incentives to comply with the guidelines on how patients should be treated at different stages. Our preliminary results show that the effectiveness of a chronic disease management program, which depends critically on targeting the right patients at the right time, may be influenced by the professional competition between the various specialists involved. In other words, the effective implementation of such programs may crucially depends on the incentive compatibility of its main operational rules (guidelines or clinical pathways) with respect to the objective functions of the physicians involved. The planners should consider how to overcome the problems due to conflicting incentives between the crucial players.
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