Organization of Health Service Clinical Trial
— TRIAPOfficial title:
TRIAP: Is Triage by Healthcare Mini-teams Effective to Improve Efficiency in Primary Health Care?
| Verified date | August 2015 |
| Source | Basque Health Service |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | Spain: Ethics Committee |
| Study type | Interventional |
Background: With new challenges for healthcare, there is a clear consensus among experts on
the need to introduce changes in the organization of care in health centres to address the
problems of over-attendance, bureaucratization and other emerging issues that require
growing amounts of attention. However, there has been insufficient research into possible
models and the impact of their adoption.
The objective is to assess the feasibility and effectiveness of the TRIAP intervention, a
new organizational model based on triage and healthcare mini-teams (two general
practitioners/pediatricians, two nurses and one member of the administrative staff) compared
to the current model, aiming to achieve a correct classification of the healthcare needs of
the primary care population and direct them to the most suitable professional.
In addition, the implementation research objective is to identify the facilitators for and
barriers to the implementation of the intervention in the context of primary care.
Methods/ design: This is a quasi-experimental controlled clinical trial to be performed in
14 healthcare mini-teams (7 intervention and 7 control groups) from 8 health centres in the
Basque Healthcare Service (Osakidetza) Interior Health Region.
The results will be assessed using the data on morbidity-adjusted attendance of users to
their family doctor, number of referral, addition of new activities to the portfolio of
services, and patient perception and professional satisfaction. All the variables will be
measured at baseline and at the end of the intervention, 24 months later.
Using covariance analysis models, the investigators will estimate the effect attributable to
the intervention by analyzing differences in changes between the two groups, and calculating
the 95% confidence interval, adjusting the comparisons for baseline values. The
investigators will also adjust for potential confounding and effect-modifying variables.
Nominal groups will be held at the end of the intervention with the participation of all the
agents involved in intervention centres to identify the facilitators for and barriers to the
implementation of the intervention.
Discussion: There is a need to develop new forms of organization in primary care services to
respond to new healthcare demands. To pursue this aim, changes have to be introduced in the
organization of healthcare within health centres, redefining the roles of primary care
professionals and refocusing their activity towards population health needs, seeking greater
efficiency in health services.
| Status | Completed |
| Enrollment | 10000 |
| Est. completion date | October 2014 |
| Est. primary completion date | October 2014 |
| Accepts healthy volunteers | Accepts Healthy Volunteers |
| Gender | Both |
| Age group | N/A and older |
| Eligibility |
Inclusion Criteria: - The study populations are patients of the seven mini-teams established, these professionals being responsible for the GP lists in the health centres of San Miguel in Basauri, Miraballes and Ondarroa, and the paediatric list in Etxebarri health centre. The control units are from the health centres of Basauri-Ariz, Arratia, Amorebieta and Bermeo, all located in the Interior Health Region. Exclusion Criteria: |
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
| Country | Name | City | State |
|---|---|---|---|
| Spain | Basque Healthcare Service | Vitoria |
| Lead Sponsor | Collaborator |
|---|---|
| Basque Health Service |
Spain,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Patients attendance | Number of visits of the patients to their GP and paediatricians in accordance to the Adjusted Clinical Groups [ACG] Case-Mix System. The patients will be classified using the ACG system, on the basis of their age, sex and ICD-9-CM codes of health problems diagnosed over a year in visits to their GP/paediatrician. The ACG case-mix system was designed by researchers at Johns Hopkins University, originally for care on an outpatient basis, and classifies the population into around 100 self-excluding categories. Regardless of the number of contacts with the healthcare services, each person is classified every year into a single ACG depending on their age, sex, and combination of diagnoses they were assigned over the previous 12 months. For this study, we will use the ACG Assignment Software version 7.00. All the tasks performed will be recorded in the Osabide computer system of the Basque Health Service. |
Baseline and at 24 months | No |
| Secondary | Patients referral: number of patient referrals by GPs and paediatricians in accordance to the Adjusted Clinical Groups [ACG] Case-Mix System. | Baseline and at 24 months | No | |
| Secondary | New activities added to the current portfolio of services | Number of programmed activities of health promotion, joint review of medical records by the doctors and nurses to improve the management of certain groups of patients, minor surgery services in PC, activities for achieving a comprehensive approach to managing non-surgical osteomuscular disorders and the use of ultrasound scans. | Baseline and at 24 months | No |
| Secondary | Patient satisfaction | Measured using the Primary Care Assessment Tool (PCAT) Pasarín MI et al. Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system. Gac Sanit. 2013 Jan-Feb;27(1):12-8. | Baseline and at 24 months | No |
| Secondary | Satisfaction of health professionals | In terms of professional quality of life measured using the Professional Quality of Life questionnaire (PQL-35). Cabezas, C. La calidad de vida de los profesionales. FMC. 2000;7 (Supl 7):53-68. |
Baseline and at 24 months | No |