Research Associate in the Primary Healthcare Research Unit and Adjunct Professor in the Division of Community Health and Humanities at Memorial University of Newfoundland in St John's, and Senior Epidemiologist in the Health Analytics and Evaluation Services Department in the Newfoundland and Labrador Centre for Health Information.
Professor in the Department of Family and Community Medicine and in the Biostatistics Division at the Dalla Lana School of Public Health at the University of Toronto in Ontario.
Can Fam Physician. 2019 Jul;65(7):e296-e304.
To examine the effects of primary health care (PHC) reforms in the Canadian province of Newfoundland and Labrador on ambulatory care-sensitive (ACS) hospitalization rates and mortality.
Interrupted time-series analysis of administrative data.
All communities in the province of Newfoundland and Labrador were divided into 3 groups: rural reform (n = 69 143), rural nonreform (n = 228 914), and urban nonreform (n = 197 012). No urban communities introduced PHC reforms.
All residents of the province who held a valid health card and did not change their address during the 2001-2009 study period were included. Individuals were assigned to 1 of the 3 study groups based on community of residence.
Hospitalization rates for ACS conditions, hospitalization rates for control conditions, and ACS-related mortality were compared using interrupted time-series models.
Results are reported as rate ratio or odds ratio (OR) (95% CI). In rural reform and rural nonreform communities, there was a decreasing trend in ACS hospitalization rates that preceded reforms (rate ratio of 0.97 [0.94-1.00]) and rate ratio of 0.98 [0.96-1.00], respectively) but no change following reforms. There were no significant changes in the urban group. In all 3 groups, there was a significant increasing trend in ACS-related mortality before reforms (OR of 1.09 [1.02-1.15], OR of 1.10 [1.06-1.13], and OR of 1.09 [1.05-1.14] for rural reform, rural nonreform, and urban communities, respectively), which was reversed after the introduction of reforms ( < .01).
Primary health care reforms in Newfoundland and Labrador had no observed effect on ACS hospitalization rates, but a potential effect might have been masked by a decreasing trend that preceded the introduction of reforms. The increase in mortality rates that was reversed after the introduction of reforms cannot be attributed to the reforms because it occurred in all studied populations including those that did not introduce reforms.
考察加拿大纽芬兰和拉布拉多省初级卫生保健（PHC）改革对非住院治疗敏感的（ACS）住院率和死亡率的影响。
对行政数据进行中断时间序列分析。
该省所有社区分为三组：农村改革（n = 69143）、农村非改革（n = 228914）和城市非改革（n = 197012）。没有城市社区引入 PHC 改革。
在 2001-2009 年研究期间，所有持有有效健康卡且未更改地址的省居民均包括在内。根据居住社区将个人分配到 3 个研究组之一。
使用中断时间序列模型比较 ACS 疾病的住院率、对照疾病的住院率和 ACS 相关死亡率。
结果以率比或比值比（OR）（95%CI）报告。在农村改革和农村非改革社区，在改革之前，ACS 住院率呈下降趋势（率比为 0.97[0.94-1.00]）和率比为 0.98[0.96-1.00]），但改革后没有变化。城市组没有明显变化。在所有 3 个组中，在改革前，ACS 相关死亡率呈显著上升趋势（OR 为 1.09[1.02-1.15]，OR 为 1.10[1.06-1.13]和 OR 为 1.09[1.05-1.14]）农村改革、农村非改革和城市社区分别），在引入改革后发生逆转（<0.01）。
纽芬兰和拉布拉多省的初级卫生保健改革对 ACS 住院率没有观察到影响，但在引入改革之前，下降趋势可能掩盖了潜在的影响。在引入改革后逆转的死亡率增加不能归因于改革，因为它发生在所有研究人群中，包括那些没有引入改革的人群。
