Team-based versus traditional primary care models and short-term outcomes after hospital discharge
| العنوان: | Team-based versus traditional primary care models and short-term outcomes after hospital discharge |
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| المؤلفون: | Patricia Li, Bruno Riverin, Erin Strumpf, Ashley I. Naimi |
| المصدر: | Canadian Medical Association Journal. 189:E585-E593 |
| بيانات النشر: | CMA Joule Inc., 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Time Factors, Patient Readmission, 01 natural sciences, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Patient-Centered Care, Outcome Assessment, Health Care, Health care, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Survival analysis, Aged, Proportional Hazards Models, Patient Care Team, business.industry, Proportional hazards model, Research, Inverse probability weighting, 010102 general mathematics, Hazard ratio, Quebec, General Medicine, Emergency department, Length of Stay, Patient Discharge, Confidence interval, Logistic Models, Health Care Reform, Chronic Disease, Emergency medicine, Female, Emergency Service, Hospital, business, Cohort study |
| الوصف: | BACKGROUND: Strategies to reduce hospital readmission have been studied mainly at the local level. We assessed associations between population-wide policies supporting team-based primary care delivery models and short-term outcomes after hospital discharge. METHODS: We extracted claims data on hospital admissions for any cause from 2002 to 2009 in the province of Quebec. We included older or chronically ill patients enrolled in team-based or traditional primary care practices. Outcomes were rates of readmission, emergency department visits and mortality in the 90 days following hospital discharge. We used inverse probability weighting to balance exposure groups on covariates and used marginal structural survival models to estimate rate differences and hazard ratios. RESULTS: We included 620 656 index admissions involving 312 377 patients. Readmission rates at any point in the 90-day post-discharge period were similar between primary care models. Patients enrolled in team-based primary care practices had lower 30-day rates of emergency department visits not associated with readmission (adjusted difference 7.5 per 1000 discharges, 95% confidence interval [CI] 4.2 to 10.8) and lower 30-day mortality (adjusted difference 3.8 deaths per 1000 discharges, 95% CI 1.7 to 5.9). The 30-day difference for mortality differed according to morbidity level (moderate morbidity: 1.0 fewer deaths per 1000 discharges in team-based practices, 95% CI 0.3 more to 2.3 fewer deaths; very high morbidity: 4.2 fewer deaths per 1000 discharges, 95% CI 3.0 to 5.3; p INTERPRETATION: Our study showed that enrolment in the newer team-based primary care practices was associated with lower rates of postdischarge emergency department visits and death. We did not observe differences in readmission rates, which suggests that more targeted or intensive efforts may be needed to affect this outcome. |
| تدمد: | 1488-2329 0820-3946 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::069544e39b3cf214c61b1b8312e4386bTest https://doi.org/10.1503/cmaj.160427Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....069544e39b3cf214c61b1b8312e4386b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14882329 08203946 |
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