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Research article
Role of Interprofessional Primary Care Teams in Preventing Avoidable Hospitalizations and Hospital Readmissions in Ontario, Canada: A Retrospective Cohort Study
Wissam Haj-Ali
University of Toronto
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1232-5702
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Health Services Research.
Background: Improving health system value and efficiency are considered major policy priorities internationally. Ontario has undergone a primary care reform that included introduction of interprofessional teams. The purpose of this study was to investigate the relationship between receiving care from interprofessional versus non-interprofessional primary care teams and ambulatory care sensitive condition (ACSC) hospitalizations and hospital readmissions.
Methods: Population-based administrative databases were linked to form data extractions of interest between the years of 2003-2005 and 2015-2017 in Ontario, Canada. The data sources were available through ICES. The Study Design was a Retrospective longitudinal cohort. We used a “difference-in-differences” approach for evaluating changes in ACSC hospitalizations and hospital readmissions before and after the introduction of interprofessional team-based primary care while adjusting for physician group, physician and patient characteristics.
Principal Findings: As of March 31st, 2017, there were a total of 778 physician groups, of which 465 were blended capitation Family Health Organization (FHOs); 177 FHOs (22.8%) were also interprofessional teams and 288 (37%) were more conventional group practices (“non-interprofessional teams”). In this period, there were a total of 13,480 primary care physicians in Ontario of whom 4,848 (36%) were affiliated with FHOs—2,311 (17.1%) practicing in interprofessional teams and 2,537 (18.8%) practicing in non-interprofessional teams. During that same period, there were 475,611 and 618,363 multi-morbid patients in interprofessional teams and non-interprofessional teams respectively out of a total of 2,920,990 multi-morbid adult patients in Ontario. There was no difference in change over time in ACSC admissions between interprofessional and non-interprofessional teams between the pre- and post intervention periods. There were no statistically significant changes in all cause hospital readmission s between the post- and pre-intervention periods for interprofessional and non-interprofessional teams.
Conclusion: Our study findings indicate that the introduction of interprofessional team-based primary care was not associated with changes in ACSC hospitalization or hospital readmissions. The findings point for the need to couple interprofessional team-based care with other enablers of a strong primary care system to improve health services utilization efficiency.
Keywords
Primary Care Reform, Primary Health Care, Avoidable Hospitalizations, Health Services Delivery, Ontario, Canada
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CURRENT STATUS: Published
Published
On 24 Aug, 2020
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Editor assigned
On 07 Aug, 2020
Editor invited
On 06 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editorial decision: Accept
On 05 Aug, 2020
Version 2
Posted 01 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 30 Jul, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
No comments provided
Review #3 received
Received 25 Jun, 2020
Editorial decision: Major revision
On 25 Jun, 2020
Review #2 received
Received 24 Jun, 2020
Reviewer #3 agreed
On 09 Jun, 2020
Reviewer #2 agreed
On 05 Jun, 2020
Reviewer #1 agreed
On 20 May, 2020
Review #1 received
Received 20 May, 2020
Editor assigned
On 17 May, 2020
Reviewers invited
Invitations sent on 17 May, 2020
Submission checks complete
On 16 May, 2020
Editor invited
On 16 May, 2020
First submitted
On 10 May, 2020
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Role of Interprofessional Primary Care Teams in Preventing Avoidable Hospitalizations and Hospital Readmissions in Ontario, Canada: A Retrospective Cohort Study
Wissam Haj-Ali
University of Toronto
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1232-5702
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 24 Aug, 2020
No community comments so far
Editor assigned
On 07 Aug, 2020
Editor invited
On 06 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editorial decision: Accept
On 05 Aug, 2020
Version 2
Posted 01 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 30 Jul, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
No comments provided
Review #3 received
Received 25 Jun, 2020
Editorial decision: Major revision
On 25 Jun, 2020
Review #2 received
Received 24 Jun, 2020
Reviewer #3 agreed
On 09 Jun, 2020
Reviewer #2 agreed
On 05 Jun, 2020
Reviewer #1 agreed
On 20 May, 2020
Review #1 received
Received 20 May, 2020
Editor assigned
On 17 May, 2020
Reviewers invited
Invitations sent on 17 May, 2020
Submission checks complete
On 16 May, 2020
Editor invited
On 16 May, 2020
First submitted
On 10 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Health Services Research.
Background: Improving health system value and efficiency are considered major policy priorities internationally. Ontario has undergone a primary care reform that included introduction of interprofessional teams. The purpose of this study was to investigate the relationship between receiving care from interprofessional versus non-interprofessional primary care teams and ambulatory care sensitive condition (ACSC) hospitalizations and hospital readmissions.
Methods: Population-based administrative databases were linked to form data extractions of interest between the years of 2003-2005 and 2015-2017 in Ontario, Canada. The data sources were available through ICES. The Study Design was a Retrospective longitudinal cohort. We used a “difference-in-differences” approach for evaluating changes in ACSC hospitalizations and hospital readmissions before and after the introduction of interprofessional team-based primary care while adjusting for physician group, physician and patient characteristics.
Principal Findings: As of March 31st, 2017, there were a total of 778 physician groups, of which 465 were blended capitation Family Health Organization (FHOs); 177 FHOs (22.8%) were also interprofessional teams and 288 (37%) were more conventional group practices (“non-interprofessional teams”). In this period, there were a total of 13,480 primary care physicians in Ontario of whom 4,848 (36%) were affiliated with FHOs—2,311 (17.1%) practicing in interprofessional teams and 2,537 (18.8%) practicing in non-interprofessional teams. During that same period, there were 475,611 and 618,363 multi-morbid patients in interprofessional teams and non-interprofessional teams respectively out of a total of 2,920,990 multi-morbid adult patients in Ontario. There was no difference in change over time in ACSC admissions between interprofessional and non-interprofessional teams between the pre- and post intervention periods. There were no statistically significant changes in all cause hospital readmission s between the post- and pre-intervention periods for interprofessional and non-interprofessional teams.
Conclusion: Our study findings indicate that the introduction of interprofessional team-based primary care was not associated with changes in ACSC hospitalization or hospital readmissions. The findings point for the need to couple interprofessional team-based care with other enablers of a strong primary care system to improve health services utilization efficiency.