Copd Performance Indicators In An Integrated Care Program And Its Impact On Health Outcomes: The Recode Cluster Randomized Trial

Abstract

Objectives: Similar to many European countries, performance-based financial incentives are introduced in the Netherlands to facilitate the implementation of integrated care programs. The aim of these programs is to enhance patients' health by improving quality of care. Performance indicators are used to measure quality of care and reward healthcare providers. However, the real benefit to patients remains largely uncertain. This study investigate (I) if implementation of an integrated care program improves performance indicators and (II) the impact performance indicators on health outcomes. Method(s): This is a sub-study of the RECODE cluster randomised controlled trial, the largest clinical trial of an integrated care program for Chronic Obstructive Pulmonary Disease (COPD) patients in primary care to date. From 38 Dutch GPs, we collected three-year prospective data on performance indicators (mostly process indicators) and health outcomes (smoking status, level of physical activity, health-related quality-of-life (HRQoL)) of 913 COPD patients. Multilevel repeated measurement models were used to assess the impact of integrated care on performance indicators and the impact of performance indicators on health outcomes. Result(s): COPD performance indicators improved over time and these improvements were higher in the integrated care group than in the usual care group, indicating improved quality of care. Four indicators (whether BMI was measured, whether physical activity was checked, whether functional status was monitored, whether a spirometry test was done) were associated with an immediate improvement (i.e. in the same year) in disease-specific HRQoL as measured with the SGRQ. The latter indicator plus 'inhalation technique checked' also had a delayed impact on HRQol (i.e. improved HRQoL in the year after the indicator was registered). The indicators related to smoking did not affect health outcomes. Conclusion(s): The integrated care program did improve performance indicators of the quality of care and some of these indicators were predictive of improved HRQoL.