Evaluating the impact of the 'Telebriefing Cardiologico' project on healthcare indicators in primary care: a difference-in- difference analysis

Background: Inappropriate cardiovascular referrals burden health systems. "Telebriefing Cardiologico" is a telementoring program connecting General Practitioners (GPs) and cardiologists in Bologna to align clinical practices. Objective: To evaluate the program's impact on cardiovascular care utilization, safety, and short-term budget. Methods: We conducted a quasi-experimental difference-in-differences (DiD) analysis using administrative data from the Bologna Local Health Authority (2022Q1–2024Q4). The cohort included 786,393 adults. We compared event rates (per 1,000 patients/quarter) for specialist visits, diagnostics, emergency department (ED) visits, and heart failure (HF) admissions between exposed and control GP clusters. Economic analysis compared tariff-based savings against delivery costs. Results: Relative to controls, the intervention group showed significant reductions in echocardiography [−1.60 (95% CI −2.49 to −0.71)], exercise testing [−0.21], and first cardiology visits [−0.85]. Inappropriate ED visits decreased markedly [−6.35]. Importantly, follow-up visits and HF admissions remained stable, suggesting preserved continuity and safety. Economically, the reduction in utilization yielded €130,664 in savings. After deducting €58,985 in staff costs, the net budget impact was a saving of €71,678 in 2024. Conclusions: Telebriefing Cardiologico reduced specific diagnostic testing and first visits without compromising patient safety or continuity. The program demonstrated efficiency gains with cost savings exceeding delivery expenses, supporting the viability of telementoring in primary-specialist care pathways.