In many countries, policies have explicitly encouraged primary care teams and inter-professional cooperation and skill mix, as a way to improve both productive efficiency gains and quality improvement. France faces barriers to developing team working as well as new and more advanced roles for health care professionals including nurses. We aim to estimate the impact of a national pilot experiment of teamwork between general practitioners (GPs) and advance practitioners nurses (APN)–who substitute and complement GPs–on yearly quality of care process indicators for type two diabetes patients (T2DP). Implemented by a not-for-profit meso-tier organisation and supported by the Ministry of Health, the pilot relied on the voluntary enrolment of newly GPs from 2012 to 2015; the staffing and training of APNs; skill mixing and new remuneration schemes. We use latent-response formulation models, control for endogeneity and selection bias by using controlled before-after and quasi-experimental design combining coarsened exact matching–prior to the treatment, at both GPs (435 treated vs 973 control) and T2DP levels –, with intention to treat (ITT; 18,310 in each group) and per protocol (PP, 2943 in each group) perspectives, as well as difference-in-differences estimates on balanced panel claims data from the National Health Insurance Fund linked to clinical data over the period 2010–2017. We show evidence of a positive and significant positive impact for T2DP followed-up by newly enrolled GPs in the pilot compared to the pretreatment period and the control group. The effect magnitudes were larger for PP than for ITT subsamples.

在许多国家，政策明确鼓励初级保健团队以及跨专业合作和技能组合，以此作为提高生产效率和提高质量的一种方式。法国在发展团队合作以及为包括护士在内的医疗保健专业人员提供新的和更高级的角色方面面临障碍。我们的目的是评估全科医生 (GP) 和高级执业护士 (APN) 之间团队合作的国家试点实验（他们替代和补充全科医生）对二型糖尿病患者 (T2DP) 的年度护理过程指标质量的影响。该试点由非营利性中层组织实施，并得到卫生部的支持，依靠 2012 年至 2015 年新全科医生的自愿注册；APN 的人员配置和培训；技能混合和新的薪酬计划。我们使用潜在反应公式模型，通过使用受控前后和准实验设计结合粗化精确匹配来控制内生性和选择偏差——治疗前，在 GP（435 名治疗组 vs 973 名对照）和 T2DP 水平上——意向治疗（ITT；每组 18,310 人）和每个方案（PP，每组 2943 人）的观点，以及对来自国家健康保险基金的平衡小组索赔数据与临床数据相关的双重差分估计2010-2017 年期间。我们的证据表明，与预处理期和对照组相比，试点中新注册的全科医生对 T2DP 随访产生了积极且显着的积极影响。PP 子样本的影响幅度大于 ITT 子样本。