Evaluating a Dutch cardiology primary care plus intervention on the Triple Aim outcomes: study design of a practice-based quantitative and qualitative research

• Published in: BMC health services research Vol. 17; no. 1; p. 628
• Main Authors: Quanjel, Tessa C C, Spreeuwenberg, Marieke D, Struijs, Jeroen N, Baan, Caroline A, Ruwaard, Dirk
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-09-2017; BioMed Central; BMC
• Subjects: Adult; Ambulatory Care - organization & administration; Ambulatory Care - standards; Analysis; Cardiology; Cardiology - organization & administration; Cardiology - standards; Care and treatment; Collaboration; Continuity of Patient Care; Delivery of Health Care, Integrated; Evidence-Based Practice; Expenditures; Health care; Health care expenditures; Health care policy; Health services; Hospital care; Hospitalization; Hospitals; Humans; Insurance policies; Intervention; Longitudinal Studies; Medical care; Medical care, Cost of; Medical referrals; Medical research; Mental health; Netherlands; Outcome Assessment (Health Care); Patients; Payment systems; Physicians; Population; Practice Guidelines as Topic; Primary care; Primary care plus; Primary Health Care - organization & administration; Primary Health Care - standards; Program Evaluation; Qualitative Research; Quality management; Referral; Study Protocol; Substitution; Surveys and Questionnaires; Triple Aim; Young Adult; Netherlands; Triple Aim; Primary care plus; Substitution; Referral; Hospital care; Cardiology; Primary care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-017-2580-x

In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+.
The study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results.
This study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes.
NTR6629 (Data registered: 25-08-2017) (registered retrospectively).