The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada

Jatinderpreet Singh,Michael E Green,Simone Dahrouge

doi:10.1186/s12875-019-0942-7

Abstract

BackgroundGreater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Although patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. This study examined the impact of the adoption of a patient rostering enhanced fee-for-service model (eFFS) on continuity, coordination of specialized care, and access.MethodA population-based longitudinal study was conducted using health administrative data from urban family practices in Ontario, Canada. Family physicians that transitioned from traditional FFS (tFFS) to eFFS between 2004 and 2013 were followed overtime. Physicians providing comprehensive primary care that had at least 4 years of pre-transition and 2 years of post-transition data were eligible. Patients were attributed to physicians on an annual basis by determining the provider that billed the largest dollar amount over a 2 year period. Outcomes of interest were the usual provider of care index (UPC), a referral index (RI) (% of total primary care referrals for a physician’s roster made by the main provider), and emergency department (ED) visits for family practice sensitive conditions (FPSCs). Mixed-effects segmented linear and logistic regressions were used to examine changes in outcomes while controlling for patient and provider contextual factors.ResultsPrior to transitioning, UPC was decreasing at a rate of 0.27%/year (95% CI: -0.34 to − 0.21, p < 0.0001). Following the transition, UPC began decreasing by an additional 0.59%/year (95% CI: -0.69 to − 0.49, p < 0.0001) relative to the pre-transition rate. RI decreased by an additional 0.34%/year (95% CI: -0.43 to − 0.24, p < 0.0001) relative to the pre-transition period, where it had been stable. The transition had minimal impact on FPSC ED visits.ConclusionContinuity and coordination of specialized care slightly decreased upon transition from tFFS to eFFS. This is likely due to physicians working in groups and sharing patients following the transition to the eFFS model. Adoption of an enrolment model with after-hours care did not decrease non-urgent ED use, which may reflect the small impact that primary care access has on these types of ED visits.

Highlights

Greater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs
This study looked at outcome measures on a yearly basis before and after practices adopted the enhanced fee-for-service model (eFFS) model using health administrative data housed at the Institute for Clinical Evaluative Sciences (ICES) from April 1st, 2000 to March 31st, 2013
This study examined the impact of transitioning from a traditional FFS (tFFS) model to an eFFS patient rostering model on access, continuity, and coordination of specialist care

Summary

Introduction

Greater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. Greater access to high quality primary care services results in improved patient health status, increased patient satisfaction, decreased use of hospital resources, and a reduction in overall health system costs [1,2,3,4]. Patient rostering (or patient enrolment) is widely considered to be a cornerstone of a high performing primary care system and is currently a key component of family practice models in countries such as Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States [9]. Adoption of patient enrolment models often require physicians to work in groups and collectively provide extended clinical hours (i.e., evenings, weekends, or holidays) for better access [10]

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Discussion

Conclusion