Does integrated care mean fewer hospitalizations? An evaluation of a French field experiment

Abstract

This study aims to evaluate the impact of an experimental healthcare policy on hospital use among elderly patients. From 2015 to 2017, French public authorities implemented an integrated care model, the Digital Health Territories (Territoire de Soins Numérique (TSN)) programme designed to improve healthcare coordination and sustain the use of health information (HI) technologies. The TSN programme was expected to reduce hospital healthcare utilization. In the Aquitaine region, the TSN programme was implemented in part of the Landes district and primarily consisted of the creation of a support platform (PTA). Part of the Lot-et-Garonne district was chosen as a "control area" due to its similarities to the experimental district in terms of the population structure and healthcare supply characteristics. In the control area, no integrated care model innovation was implemented over the study period. Using claims data from the French National Health Insurance (Système National d'Information Inter-Régimes de l'Assurance Maladie (SNIIRAM)), the healthcare utilization of the populations living in the experimental and control areas was tracked from 2012 to 2017. To estimate the impact of the TSN programme on three hospitalization outcomes, we used a combination of matching and difference-in-differences (DiD) approaches. The TSN programme shows a significant but weak negative impact on emergency department (ED) visits and no significant impact on 30-day re-hospitalizations (R30) or potentially avoidable hospitalizations (PAHs).

Keywords: Elderly; Emergency department visits; Field experiment; Health policy evaluation; Integrated care.