Improvement of integrated care with local partners

A data driven approach

Misja Mikkers

Dutch Healthcare Authority (NZa) and Tilburg University

April 20, 2023

1

Different health care systems, different trends?

2

Different health care systems, different trends?

Trends in health care cost (here illustrated by hosp cost) and outcomes are similar.They do not depend on the system.

3

And, the challenges are the same

Health care cost will continue to increase in all countries, due to better technology and an ageing population. That leads in many countries to discussions about improving health and keeping cost increases under control. The challenges in all countries are similar.

4

Contribution to health outcomes

Health outcomes are only partially influenced by the health care sector. Consensus: a broader view might enhance efficiency in providing better health.

5

Change is needed

Focus: data driven approach to stimulate cooperation in a regional setting.

6

Three levels of data analysis

Illustration of the 3 types

7

Regional collaboration of regional initiatives with the external supervisor NZa

We will provide examples from Amsterdam,Zeeland and Noord-Limburg.

In regions cooperation between health care providers, providers of care in the social domain (housing, debt relief) and funding organizations (insurers, municipalities and provinces). The regions differ in scope and reasons to cooperate.

8

Descriptive analysis: patient flows in the acute care of Zeeland

Patient flows is start of the discussion of a reorganization of the acute care. Ambition: is to integrate the triage and provision in the acute care chain.

9

Predictive analysis: Emergency Department utilization in Amsterdam

Amsterdam -> RF as starting point Emergency care specialist: why do many patients come that often with chest pain? Drill down:

10

Target population identification based on predictive model

Design intervention

11

Causal analysis: GP Practice Afferden

  • At the consultation level -> flexible consultation duration, positive health, and group interventions

  • At the practice level -> Alternative funding, coordination of high-need patients, patient information

  • At the macro level -> Collaboration in the neighborhood/municipality

12

Causal model: Difference in Difference (DiD)

13

Results of the intervention

14

Effects with uncertainty

15

Conclusion

  • Data-driven learning is important for improving health.
    • Insight into outcomes is necessary but scarce.
    • Knowledge of the context is enormously important.
    • Complete a learning cycle.
    • Exchange and link data.
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Improvement of integrated care with local partners A data driven approach Misja Mikkers Dutch Healthcare Authority (NZa) and Tilburg University April 20, 2023

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  • Improvement of integrated care with local partners
  • Different health care systems, different trends?
  • Different health care systems, different trends?
  • And, the challenges are the same
  • Contribution to health outcomes
  • Change is needed
  • Three levels of data analysis
  • Regional collaboration of regional initiatives with the external supervisor NZa
  • Descriptive analysis: patient flows in the acute care of Zeeland
  • Predictive analysis: Emergency Department utilization in Amsterdam
  • Target population identification based on predictive model
  • Causal analysis: GP Practice Afferden
  • Causal model: Difference in Difference (DiD)
  • Results of the intervention
  • Effects with uncertainty
  • Conclusion
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