Substituting hospital-based outpatient cardiology care: The impact on quality, health and costs

T. C. C. Quanjel*, M. D. Spreeuwenberg, J. N. Struijs, C. A. Baan, D. Ruwaard

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Many Western countries face the challenge of providing high-quality care while keeping the healthcare system accessible and affordable. In an attempt to deal with this challenge a new healthcare delivery model called primary care plus (PC+) was introduced in the Netherlands. Within the PC+ model, medical specialists perform consultations in a primary care setting. PC+ aims to support the general practitioners in gatekeeping and prevent unnecessary referrals to hospital care. The aim of this study was to examine the effects of a cardiology PC+ intervention on the Triple Aim outcomes, which were operationalized by patient-perceived quality of care, health-related quality of life (HRQoL) outcomes, and healthcare costs per patient.
This is a quantitative study with a longitudinal observational design. The study population consisted of patients, with non-acute and low-complexity cardiology-related health complaints, who were referred to the PC+ centre (intervention group) or hospital-based outpatient care (control group; care-as-usual). Patient-perceived quality of care and HRQoL (EQ-5D-5L, EQ-VAS and SF-12) were measured through questionnaires at three different time points. Healthcare costs per patient were obtained from administrative healthcare data and patients were followed for nine months. Chi-square tests, independent t-tests and multilevel linear models were used to analyse the data.Results:The patient-perceived quality of care was significantly higher within the intervention group for 26 out of 27 items. HRQoL outcomes did significantly increase in both groups (P <0.05) but there was no significant interaction between group and time. At baseline and also at three, six and nine months’ follow-up the healthcare costs per patient were significantly lower for patients in the intervention group (P<0.001).
While this study showed no improvements on HRQoL outcomes, PC+ seemed to be promising as it results in improved quality of care as experienced by patients and lower healthcare costs per patient.
Original languageEnglish
Article number217923
Number of pages14
Issue number5
Publication statusPublished - 2019


  • Adult
  • Ambulatory Care/economics
  • Cardiology Service, Hospital/economics
  • Cardiology/trends
  • Female
  • Health Care Costs
  • Heart Diseases/economics
  • Humans
  • Male
  • Middle Aged
  • Netherlands/epidemiology
  • Outpatients
  • Primary Health Care
  • Surveys and Questionnaires


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