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Poster Abstracts

Reduced healthcare utilisation and improved patient experience: preliminary results from a county wide integrated care pilot in Viljandi, Estonia.

Authors:

Mart Kull ,

Viljandi General Hospital, Estonia, EE
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Liis Puis,

Viljandi General Hospital, Estonia, EE
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Andres Anier,

Viljandi General Hospital, Estonia, EE
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Kadri Oras,

Viljandi General Hospital, Estonia, EE
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Saima Hinno,

Viljandi General Hospital, Estonia, EE
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Priit Tampere

Viljandi General Hospital, Estonia, EE
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Abstract

Background: Estonia is an East-European country where healthcare is financed predominantly through the single health insurance fund and the main payment model for specialist medical care is fee-for-service. There are no value-based payment models and integrated services for taking care of people with complex needs. To change this several pilot projects have emerged in the last couple of years including the Viljandi county  integrated care service initiative “Viljandi PAIK”.

Aim: To assess the impact of an integrated care-coordination service in Viljandi county to patient reported outcomes, patient experience and the healthcare services utilisation by patients with chronic diseases and complex needs. 

Methods: All the participants for the servicewereselectedfrom theresidentsofViljandicounty. Patients were eligible for the service if they were at least age sixty years old, had one or more social health determinants present and at one of the following active chronic diseases: hypertension, heart failure, chronic kidney disease, diabetes, asthma, chronic obstructive pulmonary disease or depression. Exclusion criteria included active cancer, dementia and admission already to a social care or elderly peoples home. All patients were thoroughly and holistically assessed with InterRAI questionnaire during the initiation of the service. A complete care-plan was created, responsibilities negotiated with the patient and her care team and then published in the care-management software for all care-network members to see and carry out. Patient reported outcomes eg EQ-5D were recorded at the start of the service and bi-annualy therearfter. Chronic care experience was assessed with the UK National Voices questionnaire. In this study patients with at least one follow-up assessment were included in analysis. Changes in health-care utilisation were determined through health-insurance fund claims database. 

Results: Total of 156 patients were included in pilot. The leading social health determinants were low treatment compliance (30% of all cases), recurrent hospitalisations (19% of cases) and lack of support network (17% of cases). In 19% of cases there were combined social health determinants. During the first year of the service unplanned hospitalisations rates were reduced by 43% and visits to the emergency department were reduced by 59% after service initiation. On average medication possession rate (treatment compliance) improved 9.5% after the initiation of the service. In the patient reported outcomes an improvement in the EQ-5D second domain (self-care) was observed. An improvement in patient reported experience of chronic-care was also seen in most domains.  

Conclusion: The preliminary data from the analysis of PAIK integrated care management pilot show a possible reduction in healthcare utilisation already during the first year of being on the service. In addition key patient outcome and care experience measures were significantly improved during the service. 

Limitations: This was an observational study and lacked a control group to adjust for any confounding. Also main data for the health-resource utilisation co-incided with the start of the worldwide Covid-19 pandemic, generally reducing hospitalisation rates and ER visit rates.

How to Cite: Kull M, Puis L, Anier A, Oras K, Hinno S, Tampere P. Reduced healthcare utilisation and improved patient experience: preliminary results from a county wide integrated care pilot in Viljandi, Estonia.. International Journal of Integrated Care. 2022;22(S3):263. DOI: http://doi.org/10.5334/ijic.ICIC22343
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Published on 04 Nov 2022.

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