Health care utilization and costs among coordinated care patients in Southeastern Ontario: A difference-in-differences study of a double propensity score-matched cohort.

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES Journal of Health Services Research & Policy Pub Date : 2024-11-15 DOI:10.1177/13558196241290996
Ana P Johnson, Elizabeth Hore, Walter P Wodchis, Yu Qing Bai, Luke Mondor, Tim Tenbensel, Catherine Donnelly, Michael Green, Michael Spinks, Julia Swedak, Dianne McIntyre, Ashleigh Wolfe
{"title":"Health care utilization and costs among coordinated care patients in Southeastern Ontario: A difference-in-differences study of a double propensity score-matched cohort.","authors":"Ana P Johnson, Elizabeth Hore, Walter P Wodchis, Yu Qing Bai, Luke Mondor, Tim Tenbensel, Catherine Donnelly, Michael Green, Michael Spinks, Julia Swedak, Dianne McIntyre, Ashleigh Wolfe","doi":"10.1177/13558196241290996","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Coordinated care plans (CCPs) for high-cost health care system users aim to improve system-level performance. We evaluated health care resource use and costs among CCP patients (enrollees) versus a control group that did not receive coordinated care (comparators) in Southeastern Ontario.</p><p><strong>Methods: </strong>A difference-in-differences analysis of a quasi-experimental, double propensity score-matched and adjusted cohort was conducted. Linked population-based administrative data were used to measure health care utilization and costs and to identify comparators for two enrollee groups who began CCPs between April 1, 2013, and March 31, 2019. Enrollees were recruited from hospitals in Quinte or community care centres in Rural Hastings/Thousand Islands, and were 1:1 propensity score matched to comparators. Difference-in-differences estimates were calculated using generalized estimating equations for hospitalization rates, homecare visits, primary care visits, other health care resources and total costs.</p><p><strong>Results: </strong>A total of 558 enrollees in Quinte and 538 in Rural Hastings/Thousand Islands were identified and matched to comparators. Difference-in-differences estimates were significant in both enrollee groups for number of homecare visits ([IRR 1.72; 95% CI (1.44, 2.06)] and [IRR 1.73; 95% CI (1.45, 2.06)], respectively). Number of primary care visits were 1.76 times greater for Rural Hastings/Thousand Islands enrollees versus comparators [IRR 1.76; 95% CI (1.32, 2.35)]; total costs increased by 23% ([IRR 1.23; 95% CI (1.09,1.39)].</p><p><strong>Conclusions: </strong>Homecare use significantly increased for enrollees versus comparators, indicating specific priority areas of Ontario CCPs were met. However, no reductions were shown for other health system performance indicators. We also showed increased 7-day primary care follow-up visits for community care centre-recruited patients, but not for hospital-recruited patients. Decision-makers may wish to target patients who are less advanced in their chronic disease trajectory.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196241290996"},"PeriodicalIF":1.9000,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Services Research & Policy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/13558196241290996","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: Coordinated care plans (CCPs) for high-cost health care system users aim to improve system-level performance. We evaluated health care resource use and costs among CCP patients (enrollees) versus a control group that did not receive coordinated care (comparators) in Southeastern Ontario.

Methods: A difference-in-differences analysis of a quasi-experimental, double propensity score-matched and adjusted cohort was conducted. Linked population-based administrative data were used to measure health care utilization and costs and to identify comparators for two enrollee groups who began CCPs between April 1, 2013, and March 31, 2019. Enrollees were recruited from hospitals in Quinte or community care centres in Rural Hastings/Thousand Islands, and were 1:1 propensity score matched to comparators. Difference-in-differences estimates were calculated using generalized estimating equations for hospitalization rates, homecare visits, primary care visits, other health care resources and total costs.

Results: A total of 558 enrollees in Quinte and 538 in Rural Hastings/Thousand Islands were identified and matched to comparators. Difference-in-differences estimates were significant in both enrollee groups for number of homecare visits ([IRR 1.72; 95% CI (1.44, 2.06)] and [IRR 1.73; 95% CI (1.45, 2.06)], respectively). Number of primary care visits were 1.76 times greater for Rural Hastings/Thousand Islands enrollees versus comparators [IRR 1.76; 95% CI (1.32, 2.35)]; total costs increased by 23% ([IRR 1.23; 95% CI (1.09,1.39)].

Conclusions: Homecare use significantly increased for enrollees versus comparators, indicating specific priority areas of Ontario CCPs were met. However, no reductions were shown for other health system performance indicators. We also showed increased 7-day primary care follow-up visits for community care centre-recruited patients, but not for hospital-recruited patients. Decision-makers may wish to target patients who are less advanced in their chronic disease trajectory.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
安大略省东南部协调护理患者的医疗利用率和成本:双倾向得分匹配队列的差异研究。
目标:针对高成本医疗系统用户的协调护理计划(CCP)旨在改善系统层面的绩效。我们对安大略省东南部的协调护理计划患者(参保者)与未接受协调护理计划的对照组(比较组)的医疗资源使用情况和成本进行了评估:对准实验、双倾向得分匹配和调整队列进行了差异分析。研究使用关联的人口行政数据来衡量医疗利用率和成本,并确定在 2013 年 4 月 1 日至 2019 年 3 月 31 日期间开始接受 CCP 的两个参保者群体的比较者。参保者从昆特省的医院或黑斯廷斯/千岛群岛农村地区的社区护理中心招募,并与比较者进行 1:1 的倾向评分匹配。采用广义估计方程计算住院率、家庭护理就诊率、初级护理就诊率、其他医疗资源和总成本的差异估计值:共确定了昆特省的 558 名参保者和黑斯廷斯/千岛群岛农村地区的 538 名参保者,并与比较者进行了匹配。在两个参保者群体中,家庭护理就诊次数的差异估计值都很显著([IRR 1.72; 95% CI (1.44, 2.06)]和[IRR 1.73; 95% CI (1.45, 2.06)])。黑斯廷斯/千岛农村地区参保者的初级保健就诊次数是比较者的 1.76 倍 [IRR 1.76; 95% CI (1.32, 2.35)];总费用增加了 23% ([IRR 1.23; 95% CI (1.09,1.39)]):参保者与比较者相比,家庭护理的使用率明显增加,这表明安大略省社区保健方案的特定优先领域得到了满足。然而,其他医疗系统绩效指标并没有减少。我们还发现,社区护理中心招募的患者的 7 天初级保健随访次数有所增加,而医院招募的患者则没有增加。决策者不妨将慢性病发病率较低的患者作为目标人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
期刊最新文献
Health care utilization and costs among coordinated care patients in Southeastern Ontario: A difference-in-differences study of a double propensity score-matched cohort. The role of collaborative governance in translating national cancer programs into network-based practices: A longitudinal case study in Canada. How can specialist investigation agencies inform system-wide learning for patient safety? A qualitative study of perspectives on the early years of the English healthcare safety investigation branch. What can the era of big data and big data analytics mean for health services research? Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1