Leah S Steele1, Anna Durbin2, Elizabeth Lin3, J Charles Victor4, Julie Klein-Geltink5, Richard H Glazier6, Brandon Zagorski7, Alexander Kopp8. 1. Methadone Works, Toronto, ON. 2. Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON. 3. Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON. 4. Institute for Clinical Evaluative Sciences, Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON. 5. Senior Manager, Surveillance, Cancer Care Ontario, Toronto, ON. 6. Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON. 7. Institute of Health Policy Management & Evaluation. 8. Institute for Clinical Evaluative Sciences, Toronto, ON.
Abstract
PURPOSE: To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario. METHODS: This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233). RESULTS: Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar. CONCLUSION: Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform.
PURPOSE: To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario. METHODS: This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233). RESULTS: Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar. CONCLUSION: Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform.
Authors: Anthony Scott; Peter Sivey; Driss Ait Ouakrim; Lisa Willenberg; Lucio Naccarella; John Furler; Doris Young Journal: Cochrane Database Syst Rev Date: 2011-09-07
Authors: Marian J T Oud; Jan Schuling; Klaas H Groenier; Peter F M Verhaak; Cees J Slooff; Janny H Dekker; Betty Meyboom-de Jong Journal: BMC Fam Pract Date: 2010-11-25 Impact factor: 2.497