M Ruth Lavergne1, Michael R Law2, Sandra Peterson2, Scott Garrison2, Jeremiah Hurley2, Lucy Cheng2, Kimberlyn McGrail2. 1. Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont. ruth_lavergne@sfu.ca. 2. Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
Abstract
BACKGROUND: In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs. METHODS: We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention. RESULTS: Of 155 754 eligible patients, 63.7% had at least 1 incentive payment billed. Incentive payments had no impact on primary care contacts (change in contacts per patient per month: 0.016, 95% confidence interval [CI] -0.047 to 0.078) or continuity of care (mean monthly change: 0.012, 95% CI -0.001 to 0.024) and were associated with increased total rates of hospital admission (change in hospital admissions per 1000 patients per month: 1.46, 95% CI 0.04 to 2.89), relative to preintervention trends. Annual costs per patient did not decline (mean change: $455.81, 95% CI -$2.44 to $914.08). INTERPRETATION: British Columbia's $240-million investment in this program improved compensation for physicians doing the important work of caring for complex patients, but did not appear to improve primary care access or continuity, or constrain resource use elsewhere in the health care system. Policymakers should consider other strategies to improve care for this patient population.
BACKGROUND: In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs. METHODS: We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention. RESULTS: Of 155 754 eligible patients, 63.7% had at least 1 incentive payment billed. Incentive payments had no impact on primary care contacts (change in contacts per patient per month: 0.016, 95% confidence interval [CI] -0.047 to 0.078) or continuity of care (mean monthly change: 0.012, 95% CI -0.001 to 0.024) and were associated with increased total rates of hospital admission (change in hospital admissions per 1000 patients per month: 1.46, 95% CI 0.04 to 2.89), relative to preintervention trends. Annual costs per patient did not decline (mean change: $455.81, 95% CI -$2.44 to $914.08). INTERPRETATION: British Columbia's $240-million investment in this program improved compensation for physicians doing the important work of caring for complex patients, but did not appear to improve primary care access or continuity, or constrain resource use elsewhere in the health care system. Policymakers should consider other strategies to improve care for this patient population.
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: Alex Bottle; Shamini Gnani; Sonia Saxena; Paul Aylin; Arch G Mainous; Azeem Majeed Journal: J Gen Intern Med Date: 2007-10-09 Impact factor: 5.128
Authors: Lindsay Hedden; M Ruth Lavergne; Kimberlyn M McGrail; Michael R Law; Ivy L Bourgeault; Rita McCracken; Morris L Barer Journal: Ann Fam Med Date: 2019-03 Impact factor: 5.166