title: The Intensity of Primary Care for Heart Failure Patients: A Determinant of Readmissions? The CarPaths Study: A French Region-Wide Analysis.
abstract: BACKGROUND
  We aimed to classify patients with heart failure (HF) by the style of primary care they receive.
  
  
  RESULTS
  We used the claim data (SNIIRAM: Système National d'Information Inter-Régime de l'Assurance Maladie) of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12); 484 (18%) died, and 818 (30%) were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was "low need-low intensity"; group 2 (N = 1,060) was "high need-low intensity"; and group 3 (N = 957) was "high need-high intensity". Their readmission rates were 17%, 41% and 28%, respectively.
  
  
  CONCLUSIONS
  This study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes.
authors.affiliation: Economic evaluation unit at Montpellier teaching hospital, Montpellier, France.|PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
authors.forename: Claire M
authors.identifier: http://orcid.org/0000-0002-7239-530X
authors.initials: CM
authors.lastname: Duflos
authors.affiliation: Department of Cardiology, Montpellier teaching hospital, Montpellier, France.
authors.forename: Kamila
authors.initials: K
authors.lastname: Solecki
authors.affiliation: Information Systems Unit at the Regional medical office of Assurance Maladie, Montpellier, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Papinaud
authors.affiliation: Economic evaluation unit at Montpellier teaching hospital, Montpellier, France.
authors.forename: Vera
authors.initials: V
authors.lastname: Georgescu
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.|Department of Cardiology, Montpellier teaching hospital, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.affiliation: Economic evaluation unit at Montpellier teaching hospital, Montpellier, France.|MACVIA-LR: Fighting Chronic Diseases for Active and Healthy Ageing (Reference Site of the European Innovation Partnership on Active and Healthy Ageing), Montpellier, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Mercier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D016208:Databases, Factual; D005260:Female; D005602:France; D006333:Heart Failure / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011320:Primary Health Care; D012720:Severity of Illness Index; D016019:Survival Analysis; D055815:Young Adult