Evaluation of Estonia’s enhanced care management program: protocol for a cluster randomized trial

Benjamin Daniels, Daniel Rogger, Meyhar Mohammed, Katre Vaarsi, Kevin Croke
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Abstract

Background: Estonia’s aging population faces an increasing burden of non-communicable diseases (NCDs) and a growing population suffers with multiple chronic conditions. These changes have reduced well-being and quality of life for many older Estonians, while increasing the use of high cost specialist and emergency care. In response, the Estonia Health Insurance Fund (EHIF) is working to support primary care physicians to improve care for complex patients with multiple chronic conditions. A new EHIF program, Enhanced Care Management (ECM), trains family physicians to identify complex patients, co-develop proactive care plans with them, and conduct more active outreach and management of these patients. Methods: In this protocol we describe a randomized controlled trial, developed in partnership with EHIF, to evaluate the impact of ECM training for physicians. The RCT enrolled a randomly selected 97 family physicians out of the 786 family physicians practicing in Estonia. Among those physicians’ 6,739 ECM-eligible patients, 2,389 patients were randomly selected for enrolment into the ECM program. Results: Using administrative records, we evaluated the effects of ECM enrolment on: (1) health care utilization; (2) provider management of tracer conditions; and (3) markers of quality of care such as hospital admission for primary health care-sensitive conditions. Conclusions: This protocol presents a pre-specified analysis plan for this evaluation of Estonia’s ECM  program. Trial registration: First registered with the American Economics Association, AEARCTR-0003661. Registered May 1, 2019. Retrospective secondary registration with www.clinicaltrials.gov P169891. Registered April 26, 2023.
爱沙尼亚强化护理管理计划评估:分组随机试验方案
背景:爱沙尼亚的老龄人口面临着日益沉重的非传染性疾病 (NCD) 负担,越来越多的人口患有多种慢性疾病。这些变化降低了许多爱沙尼亚老年人的福祉和生活质量,同时增加了对高成本专科和急诊护理的使用。对此,爱沙尼亚健康保险基金(EHIF)正在努力支持初级保健医生改善对患有多种慢性病的复杂病人的护理。一项新的 EHIF 计划--"强化护理管理"(ECM)--培训家庭医生识别复杂病人,与他们共同制定积极的护理计划,并对这些病人进行更积极的外展和管理:在本方案中,我们介绍了与 EHIF 合作开展的随机对照试验,以评估 ECM 培训对医生的影响。该随机对照试验从爱沙尼亚 786 名执业家庭医生中随机抽取了 97 名家庭医生。在这些医生的 6739 名符合 ECM 资格的患者中,随机抽取了 2389 名患者参加 ECM 计划:利用行政记录,我们评估了加入 ECM 对以下方面的影响:(1) 医疗保健利用率;(2) 医疗服务提供者对示踪病症的管理;(3) 医疗质量指标,如初级医疗保健敏感病症的入院率:本方案介绍了爱沙尼亚 ECM 计划评估的预设分析计划:首次在美国经济学会注册,AEARCTR-0003661。注册时间:2019 年 5 月 1 日。回顾性二次注册,www.clinicaltrials.gov P169891。注册日期为 2023 年 4 月 26 日。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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