Preparing for Accountable Care Organizations

Curnow, Randall T.; Doers, Jesse T.

doi:10.1378/chest.12-2299

Cited by 8 publications

(9 citation statements)

References 8 publications

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“…For example, recent Ontario reforms are directed towards the creation of Ontario Health Teams (OHT). OHT are groups of healthcare providers and organization that are clinically and fiscally accountable for delivering a full coordinated continuum of care to a defined geographic population [ 26 ], similar to accountable care organizations developed within the USA [ 27 ]. We would strongly suggest that attachment or rostering of a patient to a primary care provider is a key component of effective coordinated care.…”

Section: Discussionmentioning

confidence: 99%

“…We would strongly suggest that attachment or rostering of a patient to a primary care provider is a key component of effective coordinated care. Other key components, common to the management of other chronic conditions, include: team based approach [28], timely access to specialty consultations and diagnostic services, guideline based care or pathways [27,29,30], access to pulmonary rehabilitation [31], self-management supports [32,33]; all recommendations outlined in current guidelines [2,34].…”

Section: Table 1 Characteristics Of the Patient Cohort And Comparable...mentioning

confidence: 99%

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Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD)

Tranmer

Rotter

O’Donnell

et al. 2022

BMC Health Serv Res

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Introduction Care for patients with chronic obstructive pulmonary disease (COPD) is provided by both family physicians (FP) and specialists. Ideally, patients receive comprehensive and coordinated care from this provider team. The objectives for this study were: 1) to describe the family and specialist physician network of care for Ontario patients newly diagnosed with COPD and 2) to determine the associations between selected characteristics of the physician network and unplanned healthcare utilization. Methods We conducted a retrospective cohort study using Ontario health administrative data housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Ontario patients, ≥ 35 years, newly diagnosed with COPD were identified between 2005 and 2013. The FP and specialist network of care characteristics were described, and the relationship between selected characteristics (i.e., continuity of care) with unplanned healthcare utilization during the first 5 years after COPD diagnosis were determined in multivariate models. Results Our cohort consisted of 450,837 patients, mean age 61.5 (SD 14.6) years. The FP was the predominant provider of care for 86.4% of the patients. Using the Bice-Boxerman’s Continuity of Care Index (COCI), a measure reflecting care across different providers, 227,082 (50.4%) were categorized in a low COCI group based on a median cut-off. In adjusted analyses, patients in the low COCI group were more likely to have a hospital admission (OR = 2.27, 95% CI 2.20,2.22), 30-day readmission (OR = 2.44, 95% CI 2.39, 2.49) and ER visit (OR = 2.27, 95% CI 2.25, 2.29). Conclusion Higher indices of continuity of care are associated with reduced unplanned hospital use for patients with COPD. Primary care-based practice models to enhance continuity through coordination and integration of both primary and specialist care have the potential to enhance the health experience for patients with COPD and should be a health service planning priority.

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Section: Discussionmentioning

confidence: 99%

Section: Table 1 Characteristics Of the Patient Cohort And Comparable...mentioning

confidence: 99%

Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD)

Tranmer

Rotter

O’Donnell

et al. 2022

BMC Health Serv Res

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“…Both of these models encourage shared responsibility and accountability for the efficient delivery of high-quality medical and surgical services [23–25]. ACOs additionally aim to enhance value through aligned provider and system incentives [26]. To date, both of these models have focused on chronic care delivery.…”

Section: Discussionmentioning

confidence: 99%

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Ulloa

Russell

Chen

et al. 2017

BMC Health Serv Res

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BackgroundElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).MethodsRetrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.ResultsIn 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.ConclusionEconsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

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“…In an era of mounting cost and quality initiatives from clinical integration networks and accountable care organizations, we have seen care models shift from specialty silos to integrated delivery systems. 6,7 The concept of value-based care has evolved with a focus to improve efficiency, enhance the patient experience, and reduce cost. 1,8 The relatively low cost of pulmonary procedures and efficient delivery positions IP as a care model in the value-based era.…”

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confidence: 99%

Value-Based Proposition for a Dedicated Interventional Pulmonology Suite

Desai

French²,

Diamond³

et al. 2018

Chest

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Value-based care is evolving with a focus on improving efficiency, reducing cost, and enhancing the patient experience. Interventional pulmonology has the opportunity to lead an effective value-based care model. This model is supported by the relatively low cost of pulmonary procedures and has the potential to improve efficiencies in thoracic care. We discuss key strategies to evaluate and improve efficiency in interventional pulmonology practice and describe our experience in developing an interventional pulmonology suite. Such a model can be adapted to other specialty areas and may encourage a more coordinated approach to specialty care.

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Preparing for Accountable Care Organizations

Cited by 8 publications

References 8 publications

Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD)

Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD)

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Value-Based Proposition for a Dedicated Interventional Pulmonology Suite

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