Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.
CMAJ Open. 2022 Aug 9;10(3):E732-E745. doi: 10.9778/cmajo.20210307. Print 2022 Jul-Sep.
It is unknown how much of current physician home visit volume is driven by low-complexity or low-continuity visits. Our objectives were to measure physician home visit volumes and costs in Ontario from 2005/06 to 2018/19, and to compare patient characteristics and postvisit use of health care services across home visit types.
This was a retrospective cross-sectional study using health administrative data. We examined annual physician home visit volumes and costs from 2005/06 to 2018/19 in Ontario, and characteristics and postvisit use of health care services of residents who received at least 1 home visit from any physician in 2014/15 to 2018/19. We categorized home visits as palliative, provided to a patient who also received home care services or "other," and compared characteristics and outcomes between groups.
A total of 4 418 334 physician home visits were performed between 2005/06 and 2018/19. More than half (2 256 667 [51.1%]) were classified as "other" and accounted for 39.1% ($22 million) of total annual physician billing costs. From 2014/15 to 2018/19, of the 413 057 home visit patients, 240 933 (58.3%) were adults aged 65 or more, and 323 283 (78.3%) lived in large urban areas. Compared to the palliative care and home care groups, the "other" group was younger, had fewer comorbidities, and had lower rates of emergency department visits and hospital admissions in the 30 days after the visit.
About half of physician home visits in 2014/15 to 2018/19 were to patients who were receiving neither palliative care nor home care, a group that was younger and healthier, and had low use of health care services after the visit. There is an opportunity to refine policy tools to target patients most likely to benefit from physician home visits.
目前医生上门就诊的数量有多少是由低复杂性或低连续性就诊驱动的，这一点尚不清楚。我们的目的是测量安大略省 2005/06 年至 2018/19 年期间医生上门就诊的数量和费用，并比较不同类型上门就诊的患者特征和就诊后医疗服务的使用情况。
这是一项使用健康管理数据的回顾性横截面研究。我们调查了 2005/06 年至 2018/19 年安大略省每年的医生上门就诊数量和费用，并调查了 2014/15 年至 2018/19 年期间至少接受过一次上门就诊的居民的就诊特征和就诊后医疗服务的使用情况。我们将上门就诊分为姑息治疗、同时接受家庭护理服务的患者，以及“其他”，并比较了组间特征和结果。
在 2005/06 年至 2018/19 年期间，共进行了 4418334 次医生上门就诊。其中超过一半（2256667[51.1%]）被归类为“其他”，占总年度医生计费费用的 39.1%（22 亿美元）。在 2014/15 年至 2018/19 年期间，在 413057 名上门就诊患者中，240933 名（58.3%）为 65 岁及以上的成年人，323283 名（78.3%）居住在大城市地区。与姑息治疗和家庭护理组相比，“其他”组患者年龄较小，合并症较少，就诊后 30 天内急诊就诊和住院的比例较低。
在 2014/15 年至 2018/19 年期间，约一半的医生上门就诊是为既未接受姑息治疗也未接受家庭护理的患者提供的服务，这些患者年龄较小、健康状况较好，就诊后医疗服务的使用率较低。有机会完善政策工具，以针对最有可能从医生上门就诊中获益的患者。
