Department of Sport and Health Sciences, Technical University of Munich, Munich 80992, Germany.
Eur J Public Health. 2023 Dec 9;33(6):981-986. doi: 10.1093/eurpub/ckad135.
Physician networks (PNs) are a recent development in Germany, designed to improve the coordination and quality of healthcare. We compared the performance of PNs that use a standardized system of audit and feedback to that of regular care.
We analysed a large sample of claims data from Bavaria, Germany, using nearest-neighbour propensity score matching. Patients who had ambulatory care-sensitive conditions (ACSCs) and were enrolled in PNs were matched with control patients receiving regular care. We examined potentially avoidable hospitalizations related to the 13 most common ACSCs (primary endpoints), as well as processes-of-care indicators for disease prevention, pharmacotherapy and coordination of care.
There were no significant differences in rates of potentially avoidable hospitalizations between the two groups. However, the networks showed higher vaccination rates, increased participation in disease management programmes, and more frequent use of referrals when consulting specialist physicians. On average, network patients visited a greater number of specialists and had lower continuity of care compared to patients receiving regular care. Polypharmacy and PRISCUS-list prescriptions were more prevalent in the networks.
PNs using audit and feedback do not appear to perform better than regular care in preventing hospitalizations due to ACSCs. However, they do perform better in disease prevention measures while showing inconclusive results for care coordination and pharmacotherapy. Further research is needed to understand effective collaboration among providers and its impact on the quality of care within PNs.
医师网络（PN）是德国最近出现的一种新事物，旨在改善医疗保健的协调和质量。我们比较了使用标准化审核和反馈系统的 PN 与常规护理的效果。
我们使用最近邻倾向评分匹配分析了来自德国巴伐利亚州的大量索赔数据。将患有门诊治疗敏感疾病（ACSCs）并参加 PN 的患者与接受常规护理的对照患者进行匹配。我们检查了与 13 种最常见 ACSC 相关的潜在可避免住院治疗（主要终点），以及疾病预防、药物治疗和护理协调的过程指标。
两组之间潜在可避免住院治疗的发生率没有显著差异。然而，该网络显示出更高的疫苗接种率、更多地参与疾病管理计划，以及在咨询专科医生时更频繁地使用转诊。平均而言，与接受常规护理的患者相比，网络患者看的专科医生更多，并且连续性护理较差。网络中普遍存在多种药物并用和 PRISCUS 清单处方。
使用审核和反馈的 PN 似乎并没有在预防 ACSC 导致的住院治疗方面表现得比常规护理更好。然而，它们在疾病预防措施方面表现更好，而在护理协调和药物治疗方面的结果则不明确。需要进一步研究以了解提供者之间的有效合作及其对 PN 内护理质量的影响。
