Impact of Team-Based Care on Emergency Department Use

Abstract

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. METHODSWe 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 posttransition (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. RESULTSWe 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.

Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada

“…Approximately one-quarter of Ontario residents live in rural communities with fewer than 30 000 people . Rural EDs are staffed by family physicians and have visit rates that are higher than in urban areas due in part to the limited availability of other after-hours care …”

“…24 Rural EDs are staffed by family physicians and have visit rates that are higher than in urban areas due in part to the limited availability of other after-hours care. 25 Temporary virtual care billing codes were introduced in Ontario on March 14, 2020, which paid the same amount as an equivalent in-person visit during the study period. Initially, the same billing code was used for both telephone and video visits.…”

Are primary care virtual visits associated with higher emergency department use? A cross-sectional analysis from Ontario, Canada

“…21 Rural emergency departments are staffed by family physicians and although emergency department volumes are relatively low, visit rates are much higher than in urban areas, due in part to the limited availability of other after-hours care. 22 Temporary virtual care billing codes were introduced for phone and video visits in Ontario on March 14, 2020 and, during the study time period, paid the same amount as an equivalent in-person visit. Initially, the same billing code was used for phone and video.…”

Garder la porte d’entrée ouverte : assurer l’accès aux soins primaires à toute la population canadienne

“…Les soins en équipe sont préférables pour la patientèle, les prestataires de soins de santé et le système. Nos recherches en Ontario ont permis de constater que la patientèle prise en charge par des cabinets prodiguant des soins en équipe était plus susceptible de recevoir les soins recommandés pour les maladies chroniques 6 et moins susceptible d’utiliser les services d’urgence 7 . La répartition des soins dans une équipe peut aussi accroître le bien-être au travail des prestataires de soins de santé 8 et, lorsqu’exécutée correctement, accroître la patientèle dont un médecin de famille peut prendre soin 9 .…”