Brown Bag Seminar: Integrated Care, Engaging Patients and Financial Incentives: The Impact of Primary Care Nursing Programs

This paper studies the effects of Primary Care Nursing Program (PCNPs) on the use of healthcare services among patients with chronic heart failure. PCNPs are out-of-hospital services that support patients and general practitioners (GPs) by increasing engagement and promoting integrated management. Exploiting enrolment timing, we apply a dynamic difference in difference to high-frequency individual-GP-linked administrative data from the Emilia Romagna region in Italy. We estimate that PCNP enrolment reduces hospitalisations and emergency admissions for heart attacks modestly, 0.5 and 1 percentage points, respectively, within two quarters, while increasing cardiologist visits and echocardiograms by 5 and 2.5 percentage points, respectively, immediately after enrolment. Results are driven by individuals whose GPs lacked nurse support and no financial incentives for chronic disease management. Cost benefit analysis results in cost saving between, 50 and 67 million euros.