Julie De Backer1,2, Lieven Annemans3, Ruben Willems4, Fouke Ombelet5, Eva Goossens5,6,1, Katya De Groote7, Werner Budts8,9, Stéphane Moniotte10, Michèle de Hosson2, Liesbet Van Bulck5,1, Ariane Marelli11, Philip Moons5,12,13. 1. Research Foundation Flanders (FWO), Brussels, Belgium. 2. Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium. 3. Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium. 4. Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium. Ruben.Willems@ugent.be. 5. KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium. 6. Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium. 7. Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium. 8. KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium. 9. Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium. 10. Pediatric and Congenital Cardiology Division, St-Luc University Hospital, Brussels, Belgium. 11. McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, QC, Canada. 12. University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden. 13. Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Abstract
AIM: To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. METHODS: The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. RESULTS: In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (- 33%) and less pharmaceutical costs (- 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. CONCLUSION: More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.
AIM: To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. METHODS: The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. RESULTS: In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (- 33%) and less pharmaceutical costs (- 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. CONCLUSION: More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.
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