Team-based primary care lowers rate of ED visits for patients, Canadian study finds
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Patients whose physicians transitioned from an enhanced fee-for-service model to a team-based capitation model had fewer ED visits than patients who did not receive team-based care, according to data published in Annals of Family Medicine.
“Team-based care is seen as a central pillar in high-functioning primary care by professional associations and policy experts in both Canada and the U.S.,” Tara Kiran, MD, MSc, CCFP, FCFP, the Fidani Chair in Improvement and Innovation and the vice chair of quality and innovation within the department of family and community medicine at the University of Toronto, and colleagues wrote. “Yet, jurisdictions in both countries have been slow to scale up team-based care, in large part because of concerns about return on investment.”
Shifting away from fee-for-service to other payment models like capitation and team-based care will allow for more effective primary care, Kiran told Healio.
Kiran and colleagues conducted an interrupted time series analysis of annual ED visit rates before and after a transition from an enhanced fee-for-service model to either a team capitation model or a nonteam capitation model. The study cohort included adults aged 19 years or older in Ontario, Canada, with at least 3 years of outcome data before and after the transition to the team-based or nonteam-based capitation model.
The researchers enrolled 387,607 patients at team-based care practices and 1,399,103 patients at nonteam-based care practices in large cities in Ontario. The analysis also included 213,394 team patients and 380,009 nonteam patients from small towns and 65,289 team patients and 78,722 nonteam patients from rural areas.
In the team-based care model, physicians and patients had access to a team of nurses, nurse practitioners, social workers, dietitians, pharmacists and other health care professionals, according to Kiran and colleagues.
Overall, the annual rate of ED visits increased for almost all patients, irrespective of rurality. However, the researchers reported that ED visit rates increased to a lesser extent for team patients.
After the transition from the fee-for-service model, ED visit rates increased 2.4% (95% CI, 2.2-2.6) per year for team patients in big cities compared with 5.2% (95% CI, 5.1-5.3) per year for nonteam patients. Similarly, annual ED visits increased by 0.9% (95% CI, 0.7-1.1) for team patients in small towns compared with 2.9% (95% CI, 2.8-3.1) among nonteam patients, according to Kiran and colleagues. In rural areas, team patients experienced a 0.5% decline (95% CI, –0.8-0.2) in annual ED visits compared with a 1.3% increase (95% CI, 1-1.6) for nonteam patients.
The researchers reported that annual ED visit rates were 2%, 1.5% and 3.3% higher for nonteam patients compared with team patients in big cities, small towns and rural areas, respectively (P < .001).
“It’s important to take a long-term, system-wide view of cost,” Kiran said. “Team-based care and payment reform may be expensive in the short term, but in the long term it may result in reduced health care use and better health.”