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@ARTICLE{Wensing:132950,
      author       = {M. Wensing and P. K. Kolle and J. Szecsenyi and C.
                      Stock$^*$ and G. Laux},
      title        = {{E}ffects of a program to strengthen general practice care
                      on hospitalisation rates: a comparative observational
                      study.},
      journal      = {Scandinavian journal of primary health care},
      volume       = {36},
      number       = {2},
      issn         = {1502-7724},
      address      = {Abingdon},
      publisher    = {Taylor $\&$ Francis Group},
      reportid     = {DKFZ-2018-00589},
      pages        = {109 - 114},
      year         = {2018},
      abstract     = {To determine the effect of a large-scale program to
                      strengthen general practice on hospitalisation rates.This
                      observational study compared enrolled patients in the
                      program and a sample of non-participating patients from
                      non-participating GPs in the same geographic area in
                      Germany. Key components of the program are: prompt access to
                      care, comprehensiveness, continuity, empanelment,
                      data-driven quality improvement, computerized decision
                      support, and additional reimbursement of general practices.
                      The outcomes in this study were hospitalisation,
                      rehospitalisation, and avoidable hospital admission up to
                      four years after patient inclusion. Poisson regression
                      models and generalized estimating equations were used to
                      estimate intervention effects.In the baseline year, $19.1\%$
                      were hospitalised and $13.6\%$ had a potentially avoidable
                      hospitalisation, $14.5\%$ were rehospitalised within 4
                      weeks. Across the four observed years, yearly
                      hospitalisations were 9.8 to $14.9\%$ lower in enrolled
                      patients, yearly re-hospitalisations were 5.3 to $11.5\%$
                      lower, and yearly avoidable hospitalisations were 6.8 to
                      $8.6\%$ lower compared to the control cohort (all
                      differences were statistically significant). The trend in
                      the between-group difference for hospitalisations and
                      re-hospitalisations increased, while it remained stable for
                      avoidable hospitalisations.This study provides strong
                      indications for the positive impact of strong general
                      practice care on population outcomes. Key points A program
                      to strengthen general practice in Germany comprised of
                      prompt access to care, comprehensiveness, continuity,
                      empanelment, data-driven quality improvement, computerized
                      decision support, and additional reimbursement of general
                      practices. Patients who remained in the program during 4
                      years had increasingly lowered rates of hospitalisation and
                      rehospitalisation compared to a control group of patients.
                      Avoidable hospitalisations were also lower, but no trend of
                      further lowering was found. This might suggest a ceiling
                      effect to impact of strong general practice on
                      hospitalisations.},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29623749},
      doi          = {10.1080/02813432.2018.1459429},
      url          = {https://inrepo02.dkfz.de/record/132950},
}