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Developing a regional transmural care database: A roadmap.

Debbie Vermond1, Charles W Helsper1, Marlous F Kortekaas1

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Summary

A regional transmural care database (RTD) was developed to monitor collaborative patient care agreements (CPCA) between primary care physicians (PCPs) and secondary care physicians (SCPs). This initiative aims to improve joint care by providing data for reflection and discussion, fostering a learning healthcare system.

Keywords:
Data linkageMirror dataTransmural care

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Area of Science:

  • Healthcare Management
  • Health Informatics
  • Public Health

Background:

  • Primary care physicians (PCPs) and secondary care physicians (SCPs) collaboration is vital for high-quality patient care, especially in managing chronic conditions.
  • The Utrecht region in the Netherlands developed Collaborative Patient Care Agreements (CPCAs) to standardize care, but adoption has been suboptimal.
  • A regional transmural care database (RTD) was created to monitor the implementation of these CPCAs.

Purpose of the Study:

  • To develop a systematic and reproducible roadmap for creating a regional transmural care database.
  • To generate 'mirror data' from linked routine care data to support discussions between PCPs and SCPs.
  • To enhance collaborative care and support a learning healthcare system by monitoring CPCA adherence.

Main Methods:

  • Linking routine care data from primary care practices and regional hospitals via a trusted third party.
  • Developing a regional transmural care database (RTD) using data from approximately 70 primary care practices and three regional hospitals.
  • Creating a roadmap detailing organizational, administrative, technical, and legal arrangements for database development.

Main Results:

  • A comprehensive roadmap for developing a regional transmural care database was established.
  • Challenges included legal and administrative hurdles, data incompleteness, and difficulties in translating agreements into extractable data.
  • The generated 'mirror data' facilitated shared reflection and discussion between PCPs and SCPs on collaborative care.

Conclusions:

  • The developed approach provides a systematic, comprehensive, and reproducible method for creating regional transmural care databases.
  • Mirror data derived from the RTD supports the improvement of daily collaborative care between PCPs and SCPs.
  • This initiative demonstrates significant potential for fostering a learning regional healthcare system through data-driven insights.