Iwona A Bielska1, Kelly Cimek2, Dale Guenter2, Kelly O'Halloran2, Chloe Nyitray2, Linda Hunter2, Walter P Wodchis2. 1. Hamilton Niagara Haldimand Brant Local Health Integration Network (Bielska, Cimek, Hunter), Grimsby, Ont.; McMaster Family Practice (Guenter), Department of Family Medicine, McMaster University; Centre for Health Services and Policy Research (Bielska), Queen's University, Kingston, Ont.; Community and Population Health Services (O'Halloran), Hamilton Health Sciences; Integrated Decision Support (IDS) (Nyitray), Hamilton Health Sciences, Hamilton, Ont.; Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont. iwona.bielska@lhins.on.ca. 2. Hamilton Niagara Haldimand Brant Local Health Integration Network (Bielska, Cimek, Hunter), Grimsby, Ont.; McMaster Family Practice (Guenter), Department of Family Medicine, McMaster University; Centre for Health Services and Policy Research (Bielska), Queen's University, Kingston, Ont.; Community and Population Health Services (O'Halloran), Hamilton Health Sciences; Integrated Decision Support (IDS) (Nyitray), Hamilton Health Sciences, Hamilton, Ont.; Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.
Abstract
BACKGROUND: We sought to determine whether patients with a coordinated care plan developed using the Health Links model of care in the Hamilton Niagara Haldimand Brant Local Health Integration Network differed in their use of health care (no. of emergency department visits, inpatient admissions, length of inpatient stay) when compared with a matched control group of patients with no care plans. METHODS: We performed a propensity score-matched study of 12 months pre- and 12 months post-health care use. Patients who had a coordinated care plan that started between 2013 and 2015 were propensity score matched to patients in a control group. Patient information was obtained from Client Health and Related Information System, National Ambulatory Care Reporting System and Discharge Abstract Database. Differences in health care use pre- and post-index date were compared using the Wilcoxon signed-rank test. A negative binomial regression model was fit for each health care use outcome at 6 and 12 months post-index date. RESULTS: Six hundred coordinated care plan enrollees and 25 449 potential control patients were included in the matching algorithm, which resulted in 548 matched pairs (91.3%). Both groups showed decreases in health care use post-index date. Matched care plan enrollees had significantly fewer emergency department visits at 6 (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.72-0.91, p < 0.01) and 12 months post-index date (IRR 0.88, 95% CI 0.79-0.99, p < 0.05) compared with the matched controls. Other use parameters were not significantly different between care plan enrollees and the control group. INTERPRETATION: Care plan enrollees show a decrease in the number of times they visit emergency departments, which may be attributed to integrated and coordinated care planning. This association should be examined to see whether these reductions persist for more than 1 year. Copyright 2018, Joule Inc. or its licensors.
BACKGROUND: We sought to determine whether patients with a coordinated care plan developed using the Health Links model of care in the Hamilton Niagara Haldimand Brant Local Health Integration Network differed in their use of health care (no. of emergency department visits, inpatient admissions, length of inpatient stay) when compared with a matched control group of patients with no care plans. METHODS: We performed a propensity score-matched study of 12 months pre- and 12 months post-health care use. Patients who had a coordinated care plan that started between 2013 and 2015 were propensity score matched to patients in a control group. Patient information was obtained from Client Health and Related Information System, National Ambulatory Care Reporting System and Discharge Abstract Database. Differences in health care use pre- and post-index date were compared using the Wilcoxon signed-rank test. A negative binomial regression model was fit for each health care use outcome at 6 and 12 months post-index date. RESULTS: Six hundred coordinated care plan enrollees and 25 449 potential control patients were included in the matching algorithm, which resulted in 548 matched pairs (91.3%). Both groups showed decreases in health care use post-index date. Matched care plan enrollees had significantly fewer emergency department visits at 6 (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.72-0.91, p < 0.01) and 12 months post-index date (IRR 0.88, 95% CI 0.79-0.99, p < 0.05) compared with the matched controls. Other use parameters were not significantly different between care plan enrollees and the control group. INTERPRETATION: Care plan enrollees show a decrease in the number of times they visit emergency departments, which may be attributed to integrated and coordinated care planning. This association should be examined to see whether these reductions persist for more than 1 year. Copyright 2018, Joule Inc. or its licensors.
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