EVALUATING THE EFFECTIVENESS OF A CORPORATE CARE PATHWAY FOR PATIENTS WITH MULTIMORBIDITY IN THE BASQUE HEALTH SERVICE: A REGRESSION DISCONTINUITY DESIGN APPROACH
Author(s)
Ania Gorostiza, MSc1, Dabi Santano, MD2, Aitziber Etxagibel, MD2, Miguel Angel Ogueta, MD2, Igor Zabala, MD3, Lucia Garate, MSc4, Roberto Abad, BSc4, Inigo Gorostiza, PhD5, Irantzu Barrio, PhD6, Agustin Martinez, PhD7, Angel Sebastian, MD7, Eduardo Millán, MD2.
1Biosistemak Institute for Health Systems Research, Bilbao, Spain, 2Subdirectorate of Healthcare Quality and Health Results, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 3Subdirectorate of Primary Care, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 4Subdirectorate of Nursing, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 5Basurto University Hospital - Osakidetza, Bilbao, Spain, 6Department of Mathematics, University of the Basque Country UPV/EHU, Leioa, Spain, 7Internal Medicine Service, Cruces University Hospital, Osakidetza Basque Health Service, Barakaldo, Spain.
1Biosistemak Institute for Health Systems Research, Bilbao, Spain, 2Subdirectorate of Healthcare Quality and Health Results, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 3Subdirectorate of Primary Care, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 4Subdirectorate of Nursing, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain, 5Basurto University Hospital - Osakidetza, Bilbao, Spain, 6Department of Mathematics, University of the Basque Country UPV/EHU, Leioa, Spain, 7Internal Medicine Service, Cruces University Hospital, Osakidetza Basque Health Service, Barakaldo, Spain.
OBJECTIVES: As part of the Basque Health Service’s strategy to tackle chronicity, patients with multimorbidity (PMM) and a high healthcare needs risk score (RS) are enrolled in a corporate integrated care pathway. This study evaluates the effectiveness of this pathway on health outcomes - unplanned admissions, hospital bed days (HBD), mortality, emergency department (ED) visits, and potentially avoidable hospitalizations (PAH) - at 12-month follow-up.
METHODS: A retrospective cohort study was conducted using the electronic health records of PMM in the Basque Health Service, defined as having two or more chronic complex diseases by 31 December 2022. Those PMM with a RS≥6.2 were enrolled in the corporate care pathway. A sharp Regression Discontinuity Design (RDD) was employed to estimate the local effect of the care pathway at the RS=6.2 threshold. Local linear regressions with optimal mean squared error bandwidths were used, adjusted for baseline covariates. Design validity was verified via density tests (p=0.37) and covariate balance analyses (p>0.05).
RESULTS: Analyses included 43,872 patients with multimorbidity (mean age 75 years, SD=12; 41.37% female, 5.19% in the care pathway). At 12-month follow-up, the care pathway led to a statistically significant reduction in HBD (adjusted local effect: -1.81 days; 95% CI: [-3.65, -0.41]; p=0.01). Although trends for other outcomes favoured the pathway group, no statistically significant changes were observed in unplanned admissions (-0.11, 95% CI [-0.26, 0.02]; p=0.08), ED visits (-0.14, 95% CI [-0.45, 0.14]; p=0.31), PAHs (-0.02, 95% CI [-0.07, 0.03]; p=0.41), or mortality (0.00, 95% CI [-0.03, 0.04]; p=0.92).
CONCLUSIONS: The corporate strategy significantly reduced HBD for PMM at the one-year follow-up and showed a favourable but not statistically significant trend regarding unplanned admissions, ED visits, mortality or PAH. RDD provided a robust causal inference framework for evaluating a population health intervention when parallel-group designs like target trial emulation designs were not feasible.
METHODS: A retrospective cohort study was conducted using the electronic health records of PMM in the Basque Health Service, defined as having two or more chronic complex diseases by 31 December 2022. Those PMM with a RS≥6.2 were enrolled in the corporate care pathway. A sharp Regression Discontinuity Design (RDD) was employed to estimate the local effect of the care pathway at the RS=6.2 threshold. Local linear regressions with optimal mean squared error bandwidths were used, adjusted for baseline covariates. Design validity was verified via density tests (p=0.37) and covariate balance analyses (p>0.05).
RESULTS: Analyses included 43,872 patients with multimorbidity (mean age 75 years, SD=12; 41.37% female, 5.19% in the care pathway). At 12-month follow-up, the care pathway led to a statistically significant reduction in HBD (adjusted local effect: -1.81 days; 95% CI: [-3.65, -0.41]; p=0.01). Although trends for other outcomes favoured the pathway group, no statistically significant changes were observed in unplanned admissions (-0.11, 95% CI [-0.26, 0.02]; p=0.08), ED visits (-0.14, 95% CI [-0.45, 0.14]; p=0.31), PAHs (-0.02, 95% CI [-0.07, 0.03]; p=0.41), or mortality (0.00, 95% CI [-0.03, 0.04]; p=0.92).
CONCLUSIONS: The corporate strategy significantly reduced HBD for PMM at the one-year follow-up and showed a favourable but not statistically significant trend regarding unplanned admissions, ED visits, mortality or PAH. RDD provided a robust causal inference framework for evaluating a population health intervention when parallel-group designs like target trial emulation designs were not feasible.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD117
Topic
Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Personalized & Precision Medicine, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)