Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study

N E Andrew; J Kim; D A Cadilhac; V Sundararajan; A G Thrift; L Churilov; N A Lannin; M Nelson; V Srikanth; M F Kilkenny

doi:10.23889/ijpds.v4i1.1097

Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study

Int J Popul Data Sci. 2019 Aug 5;4(1):1097. doi: 10.23889/ijpds.v4i1.1097.

Authors

N E Andrew¹, J Kim^{2

3}, D A Cadilhac^{2

3}, V Sundararajan⁴, A G Thrift², L Churilov³, N A Lannin⁵, M Nelson⁶, V Srikanth¹, M F Kilkenny^{2

3}

Affiliations

¹ Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
² Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
³ Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia.
⁴ Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.
⁵ School of Allied Health, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia.
⁶ Menzies Institute for Medical Research, University of Tasmania, Hobart, Victoria, Australia.

Abstract

Introduction: The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking.

Aim: To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study.

Methods: Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken.

Analysis: The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective.

Conclusion: Completion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.

Keywords: Chronic Disease; Data Linkage; General Practitioner; Policy; Primary Health Care; Secondary Prevention; Stroke.

Grants and funding

The PRECISE study is supported by a Project grant from the National Health and Medical Research Council (1141848). The following authors are supported by fellowship funding from the NHMRC (DAC 1063761; MFK 1109426; AGT 1042600) and Heart Foundation (NAL 102055).