Emergency Department Use and Enrollment in a Medical Home Providing After-Hours Care

The Article in Brief

Emergency Department Use and Enrollment in a Medical Home Providing After-Hours Care

Tara Kiran , and colleagues

Background Compared to other high-income countries, Canada and the US have among the highest rates of emergency department use and the lowest rates of primary care physicians reporting arrangements for after-hours care. This study evaluates whether enrollment in a medical home mandated to provide after-hours care in Ontario, Canada is associated with reduced emergency department use.

What This Study Found Enrollment in a medical home mandated to provide after-hours care is associated with a small increase in emergency department visit rates. This large-scale study of all adults in Ontario enrolled in medical homes between April 1, 2005 and March 31, 2012 (n = 2,945,087) found that in the years before enrollment in a medical home, the emergency department visit rate increased by 0.8 percent per year. After medical home transition, the rate increased by 1.5 percent per year. Enrollment in a medical home was also associated with a decrease in the overall primary care visit rate but a small increase in continuity of care. The authors hypothesize that the decline in the primary care visit rate associated with medical home enrollment may help explain the counter-intuitive increase in emergency department visits. Canada's health care reforms were implemented in the context of a relatively fixed primary care workforce, and increased after-hours primary care may have been offset by a decrease in regular office hours. Another possible explanation is that introducing mandatory after-hours provision with medical homes fueled greater demand for health care.

Implications

• This study highlights the importance of prospectively evaluating reform efforts that aim to improve access to primary care after hours, the authors state.