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- Publisher Website: 10.1089/jpm.2016.0283
- Scopus: eid_2-s2.0-85017149212
- PMID: 27893954
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Article: Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study
Title | Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study |
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Authors | |
Keywords | end-of-life care family medicine general practice healthcare costs home care services hospitalization house calls palliative care palliative medicine primary care |
Issue Date | 2017 |
Citation | Journal of Palliative Medicine, 2017, v. 20, n. 4, p. 344-351 How to Cite? |
Abstract | Background: Comprehensive primary care may enhance patient experience at end of life. Objective: To examine whether belonging to different models of primary care is associated with end-of-life healthcare use and outcomes. Design: Retrospective population cohort study, using health administrative databases to describe health services and costs in the last six months of life across three primary care models: enrolled to a physician remunerated mainly by capitation, with incentives for comprehensive care and access in some to allied health practitioners (Capitation); remunerated mainly from fee-for-service (FFS) with smaller incentives for comprehensive care (Enhanced FFS); and not enrolled, seeing physicians remunerated solely through FFS (Traditional FFS). Setting: People who died from April 1, 2010 to March 31, 2013 in Ontario, Canada. Measures: Health service utilization, costs, and place of death. Results: Approximately two-thirds (62.7%) of decedents had more contact with a specialist than family physician. Those in Capitation models were more likely to have the majority of physician services provided by a family physician (44.9% vs. 38.6% in Enhanced FFS and 34.3% in Traditional FFS) and received more home care service days (mean 27.2 vs. 24.2 in Enhanced FFS and 21.7 in Traditional FFS). And 22.5% had a home visit by a family physician. Controlling for potential confounders, decedents spent significantly more days in an institution in Enhanced FFS (1.1, 95% confidence interval [CI]: 0.9-1.5) and Traditional FFS (2.2, 95% CI: 1.8-2.6) than in Capitation. Conclusion: Decedents in comprehensive primary care models received more care in the community and spent less time in institutions. |
Persistent Identifier | http://hdl.handle.net/10722/346631 |
ISSN | 2023 Impact Factor: 2.2 2023 SCImago Journal Rankings: 0.794 |
DC Field | Value | Language |
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dc.contributor.author | Howard, Michelle | - |
dc.contributor.author | Chalifoux, Mathieu | - |
dc.contributor.author | Tanuseputro, Peter | - |
dc.date.accessioned | 2024-09-17T04:12:12Z | - |
dc.date.available | 2024-09-17T04:12:12Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | Journal of Palliative Medicine, 2017, v. 20, n. 4, p. 344-351 | - |
dc.identifier.issn | 1096-6218 | - |
dc.identifier.uri | http://hdl.handle.net/10722/346631 | - |
dc.description.abstract | Background: Comprehensive primary care may enhance patient experience at end of life. Objective: To examine whether belonging to different models of primary care is associated with end-of-life healthcare use and outcomes. Design: Retrospective population cohort study, using health administrative databases to describe health services and costs in the last six months of life across three primary care models: enrolled to a physician remunerated mainly by capitation, with incentives for comprehensive care and access in some to allied health practitioners (Capitation); remunerated mainly from fee-for-service (FFS) with smaller incentives for comprehensive care (Enhanced FFS); and not enrolled, seeing physicians remunerated solely through FFS (Traditional FFS). Setting: People who died from April 1, 2010 to March 31, 2013 in Ontario, Canada. Measures: Health service utilization, costs, and place of death. Results: Approximately two-thirds (62.7%) of decedents had more contact with a specialist than family physician. Those in Capitation models were more likely to have the majority of physician services provided by a family physician (44.9% vs. 38.6% in Enhanced FFS and 34.3% in Traditional FFS) and received more home care service days (mean 27.2 vs. 24.2 in Enhanced FFS and 21.7 in Traditional FFS). And 22.5% had a home visit by a family physician. Controlling for potential confounders, decedents spent significantly more days in an institution in Enhanced FFS (1.1, 95% confidence interval [CI]: 0.9-1.5) and Traditional FFS (2.2, 95% CI: 1.8-2.6) than in Capitation. Conclusion: Decedents in comprehensive primary care models received more care in the community and spent less time in institutions. | - |
dc.language | eng | - |
dc.relation.ispartof | Journal of Palliative Medicine | - |
dc.subject | end-of-life care | - |
dc.subject | family medicine | - |
dc.subject | general practice | - |
dc.subject | healthcare costs | - |
dc.subject | home care services | - |
dc.subject | hospitalization | - |
dc.subject | house calls | - |
dc.subject | palliative care | - |
dc.subject | palliative medicine | - |
dc.subject | primary care | - |
dc.title | Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1089/jpm.2016.0283 | - |
dc.identifier.pmid | 27893954 | - |
dc.identifier.scopus | eid_2-s2.0-85017149212 | - |
dc.identifier.volume | 20 | - |
dc.identifier.issue | 4 | - |
dc.identifier.spage | 344 | - |
dc.identifier.epage | 351 | - |
dc.identifier.eissn | 1557-7740 | - |