Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs
Abstract Objectives In family medicine contrasting evidence exists on the effectiveness of team practice compared with solo practice on chronic disease management. In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the qual...
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| Veröffentlicht in: | Health policy (Amsterdam) 2013-11, Vol.113 (1), p.188-198 |
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| creator | Visca, Modesta Donatini, Andrea Gini, Rosa Federico, Bruno Damiani, Gianfranco Francesconi, Paolo Grilli, Leonardo Rampichini, Carla Lapini, Gabriele Zocchetti, Carlo Di Stanislao, Francesco Brambilla, Antonio Moirano, Fulvio Bellentani, Donata |
| description | Abstract Objectives In family medicine contrasting evidence exists on the effectiveness of team practice compared with solo practice on chronic disease management. In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the quality of care. The aim of this paper is to evaluate the impact of team practice in family medicine in six Italian regions using chronic disease management process indicators as a measure of outcome. Methods Cross-sectional studies were performed to assess impact on quality of care for diabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solo practice was approximated through performance comparison of general practitioners (GPs) adhering to a team with respect to GPs working in a solo practice. Among the 2082 practitioners working in the 6 regions those assisting 300+ patients were selected. Quality of care towards 164,267 patients having at least one of three chronic conditions was estimated for the year 2008 using administrative databases. Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes, 4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computed for each patient. For each disease the response variable associated to each physician was the average score of the patients on his/her list. A multilevel model was estimated assessing the impact of team vs. solo practice. Results No impact was found for diabetes and heart failure. For ischaemic heart disease a slightly significant impact was observed (0.040; 95% CI: 0.015, 0.065). Conclusions No significant difference was found between team practice and solo practice on chronic disease management in six Italian regions. |
| doi_str_mv | 10.1016/j.healthpol.2013.05.016 |
| format | Article |
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In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the quality of care. The aim of this paper is to evaluate the impact of team practice in family medicine in six Italian regions using chronic disease management process indicators as a measure of outcome. Methods Cross-sectional studies were performed to assess impact on quality of care for diabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solo practice was approximated through performance comparison of general practitioners (GPs) adhering to a team with respect to GPs working in a solo practice. Among the 2082 practitioners working in the 6 regions those assisting 300+ patients were selected. Quality of care towards 164,267 patients having at least one of three chronic conditions was estimated for the year 2008 using administrative databases. Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes, 4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computed for each patient. For each disease the response variable associated to each physician was the average score of the patients on his/her list. A multilevel model was estimated assessing the impact of team vs. solo practice. Results No impact was found for diabetes and heart failure. For ischaemic heart disease a slightly significant impact was observed (0.040; 95% CI: 0.015, 0.065). Conclusions No significant difference was found between team practice and solo practice on chronic disease management in six Italian regions.</description><identifier>ISSN: 0168-8510</identifier><identifier>EISSN: 1872-6054</identifier><identifier>DOI: 10.1016/j.healthpol.2013.05.016</identifier><identifier>PMID: 23800605</identifier><language>eng</language><publisher>Amsterdam: Elsevier Ireland Ltd</publisher><subject>Biological and medical sciences ; Chronic disease ; Chronic sickness ; Cross-Sectional Studies ; Diabetes ; Diabetes Mellitus - therapy ; Disease Management ; Diseases ; Doctors ; Evaluation ; Family ; Female ; GPs practice ; Group Practice - standards ; Health administration ; Health care ; Health policy ; Heart disease ; Heart Failure - therapy ; Humans ; Internal Medicine ; Ischaemic heart diseases ; Italians ; Italy ; Male ; Medical sciences ; Medical service ; Medicine ; Middle Aged ; Miscellaneous ; Myocardial Ischemia - therapy ; Outcome and Process Assessment (Health Care) ; Patients ; Physicians ; Primary Health Care - standards ; Private Practice - standards ; Process indicators ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of care ; Quality of Health Care ; Teams</subject><ispartof>Health policy (Amsterdam), 2013-11, Vol.113 (1), p.188-198</ispartof><rights>Elsevier Ireland Ltd</rights><rights>2013 Elsevier Ireland Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c555t-5b5963b5cc4c857b1d8db9aa86c0ac3d333d3a7d1c72e07d8b17effdd35fd6f33</citedby><cites>FETCH-LOGICAL-c555t-5b5963b5cc4c857b1d8db9aa86c0ac3d333d3a7d1c72e07d8b17effdd35fd6f33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.healthpol.2013.05.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27846,27905,27906,30981,45976</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28010405$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23800605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Visca, Modesta</creatorcontrib><creatorcontrib>Donatini, Andrea</creatorcontrib><creatorcontrib>Gini, Rosa</creatorcontrib><creatorcontrib>Federico, Bruno</creatorcontrib><creatorcontrib>Damiani, Gianfranco</creatorcontrib><creatorcontrib>Francesconi, Paolo</creatorcontrib><creatorcontrib>Grilli, Leonardo</creatorcontrib><creatorcontrib>Rampichini, Carla</creatorcontrib><creatorcontrib>Lapini, Gabriele</creatorcontrib><creatorcontrib>Zocchetti, Carlo</creatorcontrib><creatorcontrib>Di Stanislao, Francesco</creatorcontrib><creatorcontrib>Brambilla, Antonio</creatorcontrib><creatorcontrib>Moirano, Fulvio</creatorcontrib><creatorcontrib>Bellentani, Donata</creatorcontrib><title>Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs</title><title>Health policy (Amsterdam)</title><addtitle>Health Policy</addtitle><description>Abstract Objectives In family medicine contrasting evidence exists on the effectiveness of team practice compared with solo practice on chronic disease management. In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the quality of care. The aim of this paper is to evaluate the impact of team practice in family medicine in six Italian regions using chronic disease management process indicators as a measure of outcome. Methods Cross-sectional studies were performed to assess impact on quality of care for diabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solo practice was approximated through performance comparison of general practitioners (GPs) adhering to a team with respect to GPs working in a solo practice. Among the 2082 practitioners working in the 6 regions those assisting 300+ patients were selected. Quality of care towards 164,267 patients having at least one of three chronic conditions was estimated for the year 2008 using administrative databases. Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes, 4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computed for each patient. For each disease the response variable associated to each physician was the average score of the patients on his/her list. A multilevel model was estimated assessing the impact of team vs. solo practice. Results No impact was found for diabetes and heart failure. For ischaemic heart disease a slightly significant impact was observed (0.040; 95% CI: 0.015, 0.065). Conclusions No significant difference was found between team practice and solo practice on chronic disease management in six Italian regions.</description><subject>Biological and medical sciences</subject><subject>Chronic disease</subject><subject>Chronic sickness</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - therapy</subject><subject>Disease Management</subject><subject>Diseases</subject><subject>Doctors</subject><subject>Evaluation</subject><subject>Family</subject><subject>Female</subject><subject>GPs practice</subject><subject>Group Practice - standards</subject><subject>Health administration</subject><subject>Health care</subject><subject>Health policy</subject><subject>Heart disease</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Ischaemic heart diseases</subject><subject>Italians</subject><subject>Italy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical service</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Myocardial Ischemia - therapy</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Patients</subject><subject>Physicians</subject><subject>Primary Health Care - standards</subject><subject>Private Practice - standards</subject><subject>Process indicators</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quality of care</subject><subject>Quality of Health Care</subject><subject>Teams</subject><issn>0168-8510</issn><issn>1872-6054</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNqNktGKEzEUhoMobq2-guZG8Kb1ZDKZSb0QyqJ1YUFBBe9CJjnjpKaTMZkp1Kc33dYVvKkXIXD4_j-B7xDygsGSAateb5cdaj92Q_DLAhhfgljm-QMyY7IuFhWI8iGZ5YlcSMHgijxJaQsANefVY3JVcAmQoRn5tYlhGugeY5oSTa7_7pF2urdo6RDdTscDNTriG7qmA8Y2xJ3uDVLcaz_p0YWehpaOHd5R1KJ3uSuHx0BNF0PvDB0yh_2YaHOgN6P2Tvd08yk9JY9a7RM-O99z8vX9uy_XHxa3Hzc31-vbhRFCjAvRiFXFG2FMaaSoG2albVZay8qANtxyno-uLTN1gVBb2bAa29ZaLlpbtZzPyatT7xDDzwnTqHYuGfRe9ximpFjNRSVyjbyMVgIEF1yyy6go2UqymhWX0VJIJiuZ7cxJfUJNDClFbNVZgmKgjubVVt2bV0fzCoTK85x8fn5kanZo73N_VGfg5RnQyWjfxuzRpb-cBAblHbc-cZid7B1GlUzWZ9C6iGZUNrj_-MzbfzqMd3kVtP-BB0zbMMU-K1dMpUKB-nxc1OOeMg7ABP_GfwMzzeXd</recordid><startdate>20131101</startdate><enddate>20131101</enddate><creator>Visca, Modesta</creator><creator>Donatini, Andrea</creator><creator>Gini, Rosa</creator><creator>Federico, Bruno</creator><creator>Damiani, Gianfranco</creator><creator>Francesconi, Paolo</creator><creator>Grilli, Leonardo</creator><creator>Rampichini, Carla</creator><creator>Lapini, Gabriele</creator><creator>Zocchetti, Carlo</creator><creator>Di Stanislao, Francesco</creator><creator>Brambilla, Antonio</creator><creator>Moirano, Fulvio</creator><creator>Bellentani, Donata</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QJ</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>7TQ</scope><scope>DHY</scope><scope>DON</scope></search><sort><creationdate>20131101</creationdate><title>Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs</title><author>Visca, Modesta ; Donatini, Andrea ; Gini, Rosa ; Federico, Bruno ; Damiani, Gianfranco ; Francesconi, Paolo ; Grilli, Leonardo ; Rampichini, Carla ; Lapini, Gabriele ; Zocchetti, Carlo ; Di Stanislao, Francesco ; Brambilla, Antonio ; Moirano, Fulvio ; Bellentani, Donata</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c555t-5b5963b5cc4c857b1d8db9aa86c0ac3d333d3a7d1c72e07d8b17effdd35fd6f33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Biological and medical sciences</topic><topic>Chronic disease</topic><topic>Chronic sickness</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - therapy</topic><topic>Disease Management</topic><topic>Diseases</topic><topic>Doctors</topic><topic>Evaluation</topic><topic>Family</topic><topic>Female</topic><topic>GPs practice</topic><topic>Group Practice - standards</topic><topic>Health administration</topic><topic>Health care</topic><topic>Health policy</topic><topic>Heart disease</topic><topic>Heart Failure - therapy</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Ischaemic heart diseases</topic><topic>Italians</topic><topic>Italy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical service</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Myocardial Ischemia - therapy</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Patients</topic><topic>Physicians</topic><topic>Primary Health Care - standards</topic><topic>Private Practice - standards</topic><topic>Process indicators</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Quality of care</topic><topic>Quality of Health Care</topic><topic>Teams</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Visca, Modesta</creatorcontrib><creatorcontrib>Donatini, Andrea</creatorcontrib><creatorcontrib>Gini, Rosa</creatorcontrib><creatorcontrib>Federico, Bruno</creatorcontrib><creatorcontrib>Damiani, Gianfranco</creatorcontrib><creatorcontrib>Francesconi, Paolo</creatorcontrib><creatorcontrib>Grilli, Leonardo</creatorcontrib><creatorcontrib>Rampichini, Carla</creatorcontrib><creatorcontrib>Lapini, Gabriele</creatorcontrib><creatorcontrib>Zocchetti, Carlo</creatorcontrib><creatorcontrib>Di Stanislao, Francesco</creatorcontrib><creatorcontrib>Brambilla, Antonio</creatorcontrib><creatorcontrib>Moirano, Fulvio</creatorcontrib><creatorcontrib>Bellentani, Donata</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>PAIS Index</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><jtitle>Health policy (Amsterdam)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Visca, Modesta</au><au>Donatini, Andrea</au><au>Gini, Rosa</au><au>Federico, Bruno</au><au>Damiani, Gianfranco</au><au>Francesconi, Paolo</au><au>Grilli, Leonardo</au><au>Rampichini, Carla</au><au>Lapini, Gabriele</au><au>Zocchetti, Carlo</au><au>Di Stanislao, Francesco</au><au>Brambilla, Antonio</au><au>Moirano, Fulvio</au><au>Bellentani, Donata</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs</atitle><jtitle>Health policy (Amsterdam)</jtitle><addtitle>Health Policy</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>113</volume><issue>1</issue><spage>188</spage><epage>198</epage><pages>188-198</pages><issn>0168-8510</issn><eissn>1872-6054</eissn><abstract>Abstract Objectives In family medicine contrasting evidence exists on the effectiveness of team practice compared with solo practice on chronic disease management. In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the quality of care. The aim of this paper is to evaluate the impact of team practice in family medicine in six Italian regions using chronic disease management process indicators as a measure of outcome. Methods Cross-sectional studies were performed to assess impact on quality of care for diabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solo practice was approximated through performance comparison of general practitioners (GPs) adhering to a team with respect to GPs working in a solo practice. Among the 2082 practitioners working in the 6 regions those assisting 300+ patients were selected. Quality of care towards 164,267 patients having at least one of three chronic conditions was estimated for the year 2008 using administrative databases. Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes, 4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computed for each patient. For each disease the response variable associated to each physician was the average score of the patients on his/her list. A multilevel model was estimated assessing the impact of team vs. solo practice. Results No impact was found for diabetes and heart failure. For ischaemic heart disease a slightly significant impact was observed (0.040; 95% CI: 0.015, 0.065). Conclusions No significant difference was found between team practice and solo practice on chronic disease management in six Italian regions.</abstract><cop>Amsterdam</cop><pub>Elsevier Ireland Ltd</pub><pmid>23800605</pmid><doi>10.1016/j.healthpol.2013.05.016</doi><tpages>11</tpages></addata></record> |
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| subjects | Biological and medical sciences Chronic disease Chronic sickness Cross-Sectional Studies Diabetes Diabetes Mellitus - therapy Disease Management Diseases Doctors Evaluation Family Female GPs practice Group Practice - standards Health administration Health care Health policy Heart disease Heart Failure - therapy Humans Internal Medicine Ischaemic heart diseases Italians Italy Male Medical sciences Medical service Medicine Middle Aged Miscellaneous Myocardial Ischemia - therapy Outcome and Process Assessment (Health Care) Patients Physicians Primary Health Care - standards Private Practice - standards Process indicators Public health. Hygiene Public health. Hygiene-occupational medicine Quality of care Quality of Health Care Teams |
| title | Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs |
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