Evaluation of PC+ 2.0 in Blue Care according to Triple Aim

In April 2013, the Dutch ministry of Health designated nine regions across the Netherlands which have been labelled as pioneer sites. One of those regions is Maastricht-Heuvelland located in the southern part of the Netherlands with pioneer site Blue Care'. The Blue Care pioneer site aims to achieve more sustainable care by initiating different interventions according to the Triple Aim principle of Berwick, Nolan and Whittington. They state that to achieve high quality improvements of care three aims should be linked; reduced care costs per capita should go along with improved population health and patient experiences.
One intervention in the Blue Care Pioneer site is Primary Care Plus (PC+). This intervention focuses on care substitution in which medical specialists perform
consultations within a primary care setting. PC+ is assumed to slow down the rising health care spending by reducing referrals to hospital care, minimizing diagnostic procedures and follow-up visits in hospital care and by avoiding unnecessary care loops.



PC+ is an innovative, intensive primary-secondary care collaboration model that blurs the boundaries between primary (GP) and secondary (hospital) care.
PC+ knows various manifestations in health care. In the region Maastricht-Heuvelland PC+ medical specialists work in a neutral setting, consisting of two
health care centers located in Maastricht (outside the hospital MUMC+) to minimize unnecessary referrals to and subsequent use of hospital care. PC+
focuses on relatively uncomplicated, non-acute health problems which can be diagnosed and treated successfully in a primary care setting complemented by the necessary specialist knowledge. The GP decides whether a patient's complaint is suitable for referral to PC+. A referral by the GP is necessary to
gain access to PC+.



Medical specialists from several specialties (internal medicine, neurology, orthopedics, dermatology, ophthalmology, rheumatology, ENT, gynecology,
urology and in time possibly other specialties) give consultations in two PC+ health care centers located in the western and eastern part of Maastricht.
Patients with non-complex, non-acute symptoms, who are normally referred to hospital care, are eligible for PC+. The consultation in PC+ consists of a
shortened medical specialist's consultation, with minimal diagnostic tools (comparable with a primary care setting) available. Medical specialists examine
patients, independently from the GP. After the consultation, the medical specialist gives feedback to the referring GP. In the feedback message, the
medical specialist gives advice to the GP for further treatment by the GP in the primary care setting, or advices referral to secondary hospital care for further
diagnosis and/or treatment. The medical specialist deliberates with the GP, but GPs stay in charge.

To evaluate PC+, referrals to a medical specialist in the hospital (MUMC+) are used as a control group. The care provided by the medical specialist may
consist of one or more consultations, diagnostics, and treatment.

The aim/hypothesis is that PC+ results in lower health care costs compared with usual care, while maintaining or enhancing the health status and experience with care of the patients.

T0 (after contact with TIPP or with the GP and before the consultation with the medical specialist in PC+/ hospital)

T1 (1 week after the first consultation with the medical specialist in PC+/hospital)

T2 (3 months after first consult with medical specialist in PC+/hospital)

Primary Care Plus (PC+): This
intervention focuses on care substitution in which medical specialists perform consultations within a primary care setting. PC+ is assumed to slow down therising health care spending by reducing referrals to hospital_ care, minimizingdiagnostic procedures and follow-up visits in hospital care and by avoiding
unnecessary care loops.