Impact of Team-Based Care on Emergency Department Use

被引:15
作者
Kiran, Tara [1 ,2 ,3 ,4 ,5 ]
Moineddin, Rahim [3 ,4 ]
Kopp, Alexander [4 ]
Glazier, Richard H. [1 ,2 ,3 ,4 ,5 ]
机构
[1] St Michaels Hosp, Dept Family & Community Med, Toronto, ON, Canada
[2] St Michaels Hosp, MAP Ctr Urban Hlth Solut, 30 Bond St, Toronto, ON M5B 1W8, Canada
[3] Univ Toronto, Fac Med, Dept Family & Community Med, Toronto, ON, Canada
[4] ICES, Toronto, ON, Canada
[5] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
primary care; utilization; team-based care; interdisciplinary health team; capitation fee; healthcare financing; physician payment models; emergency department use; patient-centered care; health care reform; health policy; primary care practice models; practice-based research; HEALTH; TIME; MANAGEMENT;
D O I
10.1370/afm.2728
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE We sought to assess the impact of team-based care on emergency department (ED) use in the context of physicians transitioning from fee-for-service payment to capitation payment in Ontario, Canada. METHODS We conducted an interrupted time series analysis to assess annual ED visit rates before and after transition from an enhanced fee-for-service model to either a team capitation model or a nonteam capitation model. We included Ontario residents aged 19 years and older who had at least 3 years of outcome data both pretransition and post-transition (N = 2,524,124). We adjusted for age, sex, income quintile, immigration status, comorbidity, and morbidity, and we stratified by rurality. A sensitivity analysis compared outcomes for team vs nonteam patients matched on year of transition, age, sex, rurality, and health region. RESULTS We compared 387,607 team and 1,399,103 nonteam patients in big cities, 213,394 team and 380,009 nonteam patients in small towns, and 65,289 team and 78,722 nonteam patients in rural areas. In big cities, after adjustment, the ED visit rate increased by 2.4% (95% CI, 2.2% to 2.6%) per year for team patients and 5.2% (95% CI, 5.1% to 5.3%) per year for nonteam patients in the years after transition (P <.001). Similarly, there was a slower increase in ED visits for team relative to nonteam patients in small towns (0.9% [95% CI, 0.7% to 1.1%] vs 2.9% [95% CI, 2.8% to 3.1%], P <.001) and rural areas (-0.5% [95% CI, -0.8% to 0.2%] vs 1.3% [95% CI, 1.0% to 1.6%], P <.001). Results were much the same in the matched analysis. CONCLUSIONS Adoption of team-based primary care may reduce ED use. Further research is needed to understand optimal team composition and roles.
引用
收藏
页码:24 / 31
页数:8
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