Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study

Abstract

Background: Health Links are a new model of providing care coordination for high-cost, high-needs patients in Ontario. We evaluated use of hospital-related health care services among Health Links patients in the Central Local Health Integration Network (LHIN) of Ontario in the year before versus after program enrolment and compared rates of use with those among similar patients with complex needs not enrolled in the program (comparator group). Methods:We identified all patients who received a Health Links coordinated care plan before Jan. 1, 2015, using linked registry and health administrative data. We used propensity scores to match (1:1) enrollees (registry) with comparator patients (administrative data). Using a difference-in-differences approach with generalized estimating equations, we evaluated 5 measures of Health Link performance: rates of hospital admission, emergency department visits, days in acute care, 30-day readmissions and 7-day postdischarge primary care follow-up. Results:Of the 344 enrollees in the registry, we matched 313 [91.0%] to comparator patients. All measured sociodemographic, comorbidity and health care use characteristics were balanced between the 2 groups (all standardized differences < 0.10). For enrollees, the rate of days in acute care per person-year increased by 35% (incidence rate ratio 1.35 [confidence interval 1.11-1.65]) after versus before the index date, but differences were nonsignificant for all other measures. Difference-in-differences analyses revealed greater reductions in hospital admissions, emergency department visits and acute care days after the index date in the comparator group than among enrollees.

Effect of a multimorbidity intervention on health care utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses

“…14 Results are also consistent with similar interventions. 11,12 Another propensitymatched study of a community intervention called Health Links for people with multiple chronic conditions in Ontario found no effect on acute hospital admissions, readmissions or timely follow-up with primary care providers 7 days after hospital discharge. 11 This study included components similar to those in the PACE in MM RCT, such as intensive care coordination, multidisciplinary care and a patient-centred coordinated care plan outlining the patient's needs, goals, providers, treatments and appointments.…”

“…[3][4][5] Although interventions aimed at improving health care, including for complex patients, have been mounted in Ontario, few have been evaluated. 6 Further, interventions specifically targeted for patients with multimorbidity worldwide have had mixed results; [7][8][9][10][11][12] only 2 11,12 have examined the effect of interventions on health care utilization.…”

A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study

“…The program connects them to primary care providers and engages them in their health care via active care planning [28]. These patients are considered high-cost, high-need users of the health care system-the top 5% of the population who use two-thirds of the health care spending [33]. GENIE was implemented with a small sample of Health Links patients within the context of the Health TAPESTRY program.…”

Implementing Coordinated Care Networks: The Interplay of Individual and Distributed Leadership Practices

“…In a previous multimethod comparative case study evaluation, three coordinated care networks known as Health Links in one region in Ontario, Canada, were studied using semistructured interviews, surveys, document review, and administrative data ( Gutberg et al, 2017 ; Mondor et al, 2016 ). The three cases were purposefully selected because they were “early adopters” of a government policy aimed at stimulating the development of coordinated care networks.…”

“…However, funding was limited and was not used to provide additional health services. Enrolled populations for all Health Link networks range in size from 13,000 to 76,000 ( Mondor et al, 2016 ). Coordinated Care Plans were used to establish a patient’s care team, document patient goals, and facilitate communication among a diverse team of providers.…”