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Team-based versus traditional primary care models and short-term outcomes after hospital discharge.

Abstract Strategies to reduce hospital readmission have been studied mainly at the local level. We assessed associations between population-wide policies supporting team-based primary care delivery models and short-term outcomes after hospital discharge.
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Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28438951
OWN - NLM
STAT- MEDLINE
DA  - 20170425
DCOM- 20170502
LR  - 20170502
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 16
DP  - 2017 Apr 24
TI  - Team-based versus traditional primary care models and short-term outcomes after
      hospital discharge.
PG  - E585-E593
LID - 10.1503/cmaj.160427 [doi]
AB  - BACKGROUND: Strategies to reduce hospital readmission have been studied mainly at
      the local level. We assessed associations between population-wide policies
      supporting team-based primary care delivery models and short-term outcomes after 
      hospital discharge. METHODS: We extracted claims data on hospital admissions for 
      any cause from 2002 to 2009 in the province of Quebec. We included older or
      chronically ill patients enrolled in team-based or traditional primary care
      practices. Outcomes were rates of readmission, emergency department visits and
      mortality in the 90 days following hospital discharge. We used inverse
      probability weighting to balance exposure groups on covariates and used marginal 
      structural survival models to estimate rate differences and hazard ratios.
      RESULTS: We included 620 656 index admissions involving 312 377 patients.
      Readmission rates at any point in the 90-day post-discharge period were similar
      between primary care models. Patients enrolled in team-based primary care
      practices had lower 30-day rates of emergency department visits not associated
      with readmission (adjusted difference 7.5 per 1000 discharges, 95% confidence
      interval [CI] 4.2 to 10.8) and lower 30-day mortality (adjusted difference 3.8
      deaths per 1000 discharges, 95% CI 1.7 to 5.9). The 30-day difference for
      mortality differed according to morbidity level (moderate morbidity: 1.0 fewer
      deaths per 1000 discharges in team-based practices, 95% CI 0.3 more to 2.3 fewer 
      deaths; very high morbidity: 4.2 fewer deaths per 1000 discharges, 95% CI 3.0 to 
      5.3; p < 0.001). INTERPRETATION: Our study showed that enrolment in the newer
      team-based primary care practices was associated with lower rates of
      postdischarge emergency department visits and death. We did not observe
      differences in readmission rates, which suggests that more targeted or intensive 
      efforts may be needed to affect this outcome.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Riverin, Bruno D
AU  - Riverin BD
AD  - Department of Epidemiology, Biostatistics and Occupational Health (Riverin, Li,
      Strumpf), McGill University; Department of Pediatrics (Riverin, Li), Montreal
      Children's Hospital, McGill University Health Centre, Montreal, Que.; Department 
      of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public
      Health, Pittsburgh, Penn.; Direction de la sante publique du CIUSS du
      Centre-Sud-de-l'Ile-de-Montreal (Strumpf); Department of Economics (Strumpf),
      McGill University, Montreal, Que. [email protected]
FAU - Li, Patricia
AU  - Li P
AD  - Department of Epidemiology, Biostatistics and Occupational Health (Riverin, Li,
      Strumpf), McGill University; Department of Pediatrics (Riverin, Li), Montreal
      Children's Hospital, McGill University Health Centre, Montreal, Que.; Department 
      of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public
      Health, Pittsburgh, Penn.; Direction de la sante publique du CIUSS du
      Centre-Sud-de-l'Ile-de-Montreal (Strumpf); Department of Economics (Strumpf),
      McGill University, Montreal, Que.
FAU - Naimi, Ashley I
AU  - Naimi AI
AD  - Department of Epidemiology, Biostatistics and Occupational Health (Riverin, Li,
      Strumpf), McGill University; Department of Pediatrics (Riverin, Li), Montreal
      Children's Hospital, McGill University Health Centre, Montreal, Que.; Department 
      of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public
      Health, Pittsburgh, Penn.; Direction de la sante publique du CIUSS du
      Centre-Sud-de-l'Ile-de-Montreal (Strumpf); Department of Economics (Strumpf),
      McGill University, Montreal, Que.
FAU - Strumpf, Erin
AU  - Strumpf E
AD  - Department of Epidemiology, Biostatistics and Occupational Health (Riverin, Li,
      Strumpf), McGill University; Department of Pediatrics (Riverin, Li), Montreal
      Children's Hospital, McGill University Health Centre, Montreal, Que.; Department 
      of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public
      Health, Pittsburgh, Penn.; Direction de la sante publique du CIUSS du
      Centre-Sud-de-l'Ile-de-Montreal (Strumpf); Department of Economics (Strumpf),
      McGill University, Montreal, Que.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
SB  - AIM
SB  - IM
MH  - Aged
MH  - Chronic Disease/*mortality
MH  - Cohort Studies
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Health Care Reform/*methods
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Logistic Models
MH  - Male
MH  - Outcome Assessment (Health Care)
MH  - Patient Care Team/*standards
MH  - Patient Discharge
MH  - Patient Readmission/economics/*statistics & numerical data
MH  - Patient-Centered Care/*standards
MH  - Proportional Hazards Models
MH  - Quebec
MH  - Time Factors
PMC - PMC5403641
COI - Competing interests: None declared.
EDAT- 2017/04/26 06:00
MHDA- 2017/05/04 06:00
CRDT- 2017/04/26 06:00
PHST- 2017/01/03 [accepted]
AID - 189/16/E585 [pii]
AID - 10.1503/cmaj.160427 [doi]
PST - ppublish
SO  - CMAJ. 2017 Apr 24;189(16):E585-E593. doi: 10.1503/cmaj.160427.

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