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Research ArticleOriginal Research

Impact of Team-Based Care on Emergency Department Use

Tara Kiran, Rahim Moineddin, Alexander Kopp and Richard H. Glazier
The Annals of Family Medicine January 2022, 20 (1) 24-31; DOI: https://doi.org/10.1370/afm.2728
Tara Kiran
1Department of Family and Community Medicine and the MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
2Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
3ICES, Toronto, Ontario, Canada
4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
MD, MSc
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Rahim Moineddin
2Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
3ICES, Toronto, Ontario, Canada
PhD
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Alexander Kopp
3ICES, Toronto, Ontario, Canada
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Richard H. Glazier
1Department of Family and Community Medicine and the MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
2Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
3ICES, Toronto, Ontario, Canada
4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
MD, MPH
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    Figure 1.

    Unadjusted mean ED visit rate before and after transition to a capitation model with vs without team care, stratified by rurality.

  • Figure 2.
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    Figure 2.

    Adjusted mean ED visit rate before and after transition to a team vs nonteam capitation model, stratified by rurality.

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    Table 1.

    Characteristics of Patients Enrolled With Physicians Who Transitioned to Team Capitation and Nonteam Capitation Between 2007 and 2013, Stratified by Rurality

    Big CitiesSmall TownsRural Areas
    CharacteristicTotal (N = 2,524,124)Team (n = 387,607)Nonteam (n = 1,399,103)Team (n = 213,394)Nonteam (n = 380,009)Team (n = 65,289)Nonteam (n = 78,722)
    Age, mean (SD), y48.8 (17.3)46.9 (17.4)48.6 (17.3)50.1 (17.4)49.8 (17.2)50.5 (17.3)50.6 (17.0)
    Age group, No. (%)
        19-44 years1,064,120 (42.2)185,101 (47.8)598,969 (42.8)82,145 (38.5)146,004 (38.4)24,147 (37.0)27,754 (35.3)
        45-64 years967,324 (38.3)135,925 (35.1)531,538 (38.0)85,103 (39.9)154,357 (40.6)26,514 (40.6)33,887 (43.0)
        ≥65 years492,680 (19.5)66,581 (17.2)268,596 (19.2)46,146 (21.6)79,648 (21.0)14,628 (22.4)17,081 (21.7)
        Female, No. (%)1,392,513 (55.2)223,637 (57.7)770,943 (55.1)117,335 (55.0)203,019 (53.4)36,163 (55.4)41,416 (52.6)
    Morbidity, No. (%)
        0 RUB (none)83,116 (3.3)9,432 (2.4)48,766 (3.5)6,661 (3.1)13,594 (3.6)1,712 (2.6)2,951 (3.7)
        1 RUB117,770 (4.7)16,954 (4.4)65,169 (4.7)9,620 (4.5)19,236 (5.1)2,941 (4.5)3,850 (4.9)
        2 RUB397,301 (15.7)60,932 (15.7)217,742 (15.6)32,934 (15.4)62,304 (16.4)10,315 (15.8)13,074 (16.6)
        3 RUB1,409,699 (55.8)216,123 (55.8)787,492 (56.3)117,291 (55.0)209,203 (55.1)35,778 (54.8)43,812 (55.7)
        4 RUB393,209 (15.6)64,734 (16.7)215,365 (15.4)34,597 (16.2)56,496 (14.9)10,831 (16.6)11,186 (14.2)
        5 RUB (high)123,029 (4.9)19,432 (5.0)64,569 (4.6)12,291 (5.8)19,176 (5.0)3,712 (5.7)3,849 (4.9)
    Comorbidity, No. (%)
        No health care use83,132 (3.3)9,434 (2.4)48,775 (3.5)6,662 (3.1)13,597 (3.6)1,713 (2.6)2,951 (3.7)
        1-4 ADG (low)1,034,648 (41.0)156,831 (40.5)556,057 (39.7)91,078 (42.7)165,481 (43.5)28,966 (44.4)36,235 (46.0)
        5-9 ADG1,139,347 (45.1)178,458 (46.0)639,695 (45.7)93,927 (44.0)165,313 (43.5)28,617 (43.8)33,337 (42.3)
        ≥10 ADG (high)266,997 (10.6)42,884 (11.1)154,576 (11.0)21,727 (10.2)35,618 (9.4)5,993 (9.2)6,199 (7.9)
        Recent immigration (past 10 years), No. (%)141,617 (5.6)29,229 (7.5)98,386 (7.0)4,060 (1.9)7,281 (1.9)1,016 (1.6)1,645 (2.1)
    Income quintile, No. (%)
        Q1 (lowest)401,788 (15.9)69,877 (18.0)227,491 (16.3)31,298 (14.7)45,227 (11.9)14,963 (22.9)12,932 (16.4)
        Q2455,529 (18.0)70,199 (18.1)252,220 (18.0)36,878 (17.3)62,199 (16.4)15,838 (24.3)18,195 (23.1)
        Q3490,449 (19.4)73,231 (18.9)264,609 (18.9)44,084 (20.7)79,038 (20.8)14,047 (21.5)15,440 (19.6)
        Q4558,640 (22.1)84,190 (21.7)298,542 (21.3)51,299 (24.0)98,129 (25.8)10,573 (16.2)15,907 (20.2)
        Q5 (highest)609,691 (24.2)89,012 (23.0)353,507 (25.3)49,299 (23.1)94,818 (25.0)8,651 (13.3)14,404 (18.3)
        Missing8,027 (0.3)1,098 (0.3)2,734 (0.2)536 (0.3)598 (0.2)1,217 (1.9)1,844 (2.3)
    Year of transition, No. (%)
        2006-2007134,819 (5.3)56,707 (14.6)589 (0.0)54,684 (25.6)205 (0.1)22,594 (34.6)40 (0.1)
        2007-2008339,919 (13.5)95,676 (24.7)113,226 (8.1)38,020 (17.8)64,554 (17.0)10,736 (16.4)17,707 (22.5)
        2008-2009731,873 (29.0)75,870 (19.6)422,253 (30.2)38,896 (18.2)152,336 (40.1)8,287 (12.7)34,231 (43.5)
        2009-2010461,777 (18.3)48,807 (12.6)288,494 (20.6)22,450 (10.5)79,893 (21.0)4,602 (7.0)17,531 (22.3)
        2010-2011400,493 (15.9)33,111 (8.5)278,884 (19.9)30,941 (14.5)45,492 (12.0)8,075 (12.4)3,990 (5.1)
        2011-2012336,868 (13.3)54,795 (14.1)220,486 (15.8)21,703 (10.2)28,312 (7.5)8,393 (12.9)3,179 (4.0)
        2012-2013118,375 (4.7)22,641 (5.8)75,171 (5.4)6,700 (3.1)9,217 (2.4)2,602 (4.0)2,044 (2.6)
    • ADG = adjusted diagnosis groups; Q = quintile; RUB = resource utilization band.

    • View popup
    Table 2.

    Change in Annual ED Visit Rate With Transition to Capitation, Team vs Nonteam, Stratified by Rurality

    MeasureBig CitiesSmall TownsRural Areas
    TeamNonteamTeamNonteamTeamNonteam
    Trend in annual rate before transition, % (95% CI)2.31.50.71.12.31.6
    (2.1 to 2.5)(1.4 to 1.6)(0.4 to 0.9)(0.9 to 1.2)(1.8 to 2.7)(1.2 to 1.9)
    Trend in annual rate after transition, % (95% CI)2.45.20.92.9–0.51.3
    (2.2 to 2.6)(5.1 to 5.3)(0.7 to 1.1)(2.8 to 3.1)(–0.8 to 0.2)(1.0 to 1.6)
    Change in trend, % (95% CI)–0.7–2.20.2–0.57.80.9
    (–14.8 to 0.1)(–2.6 to 1.7)(–0.7 to 1.2) (–1.1 to 0.2)(6.0 to 9.5) (–0.5 to 2.3)
    Difference between groups in post-transition rate trend,a %2.92.11.8
    P value<.001<.001<.001
    • ED = emergency department.

    • aNonteam minus team.

    • Note: Adjusted for patient’s age, sex, neighborhood income quintile, recent immigration, comorbidity, and morbidity.

Additional Files

  • Figures
  • Tables
  • Supplemental materials in pdf file below

    Supplemental Figure 1. Selection of patients whose physician transitioned to team-based capitation and patients whose physician transitioned to non-team capitation between 2007 and 2013, Ontario, Canada. 

    Supplemental Table 1. Select characteristics of patients whose physician transitioned to team-based capitation and matched patients whose physician transitioned to non-team capitation between 2007 and 2013, stratified by rurality, Ontario, Canada. 

    Supplemental Figure 2. Details on the negative binomial regression modeling 

    Supplemental Table 2. Number of Ontario residents included in denominator by year for the unmatched and matched analysis 

    Supplemental Table 3. Change in emergency department visit rate after transition to capitation, team-based versus non-team for matched data, 2007 – 2013, stratified by rurality, Ontario, Canada. 

    Supplemental Figure 3. Mean emergency department visit rate before and after transition to a capitation-based primary care model between 2007 - 2013, with a team or without a team for matched data, stratified by rurality, Ontario, Canada. 

    • Kiran.pdf -

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Impact of Team-Based Care on Emergency Department Use
Tara Kiran, Rahim Moineddin, Alexander Kopp, Richard H. Glazier
The Annals of Family Medicine Jan 2022, 20 (1) 24-31; DOI: 10.1370/afm.2728

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Impact of Team-Based Care on Emergency Department Use
Tara Kiran, Rahim Moineddin, Alexander Kopp, Richard H. Glazier
The Annals of Family Medicine Jan 2022, 20 (1) 24-31; DOI: 10.1370/afm.2728
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