Sheng Ruixi, Tranmer Joan E, Godfrey Christina, Rotter Thomas
Queen's University, Kingston, ON, Canada.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231201080. doi: 10.1177/21501319231201080.
Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease. Most of the care for this population occurs within the primary care setting; however, the extent to which different primary care practice models influence the outcomes of patients with COPD remains unclear.
The study aimed to compare and analyze the influence of different primary care practice models on indicators of unplanned health care utilization among newly diagnosed COPD patients in Ontario.
A retrospective cohort study was conducted using health administrative database within the Institute for Clinical Evaluative Sciences. The cohort included persons who were 35 years and older with physician-diagnosed COPD between January 1, 2014 and December 31, 2019. Patients were assigned into 3 practice models: team-based, traditional, and no enrolment. The primary outcomes examined was unplanned health care utilization, specifically emergency department (ED) visits and hospitalizations. To account for excessive zero values, the zero inflated negative binomial (ZINB) models were used to analyze the association between different practice models and unplanned health care utilization.
Among 57,145 individuals who met the inclusion criteria, 55,994 were included in the regression analysis. Of the included participants, 62.8% of patients were in the traditional group, 30.3% were in the team-based group, and 6.9% were in the no enrolment group. Between 2014 and 2019, 70.7% of the cohort had at least 1 all-cause ED visit without hospitalization. The adjusted ZINB models showed no significant difference in risks of experiencing an unplanned health care utilization between the team-based and traditional groups. However, patients in the no enrolment group had a significantly higher risk of ED visit without hospitalization regardless of cause, ED visit with hospitalization regardless of cause, and 30-day readmissions regardless of cause.
Primary care practice models are complex, influenced by remuneration and organizational structures, reinforcing the need for further research to enhance our understanding of primary care reforms. Furthermore, given the growing shortage of primary care providers, patients with COPD and other chronic conditions are particularly vulnerable.
慢性阻塞性肺疾病（COPD）是一种高度流行的慢性疾病。该人群的大多数护理在初级保健机构中进行；然而，不同的初级保健实践模式对COPD患者结局的影响程度仍不清楚。
本研究旨在比较和分析不同的初级保健实践模式对安大略省新诊断的COPD患者非计划医疗保健利用指标的影响。
使用临床评价科学研究所的卫生行政数据库进行了一项回顾性队列研究。该队列包括2014年1月1日至2019年12月31日期间年龄在35岁及以上且经医生诊断为COPD的患者。患者被分为3种实践模式：团队模式、传统模式和未登记模式。所检查的主要结局是非计划医疗保健利用，特别是急诊室（ED）就诊和住院。为了处理过多的零值，使用零膨胀负二项式（ZINB）模型来分析不同实践模式与非计划医疗保健利用之间的关联。
在符合纳入标准的57145名个体中，55994名被纳入回归分析。在纳入的参与者中，62.8%的患者在传统组，30.3%在团队模式组，6.9%在未登记组。在2014年至2019年期间，70.7%的队列至少有1次全因急诊室就诊但未住院。调整后的ZINB模型显示，团队模式组和传统模式组在经历非计划医疗保健利用的风险方面没有显著差异。然而，无论何种原因，未登记组的患者无住院的急诊室就诊、无论何种原因的住院急诊室就诊以及无论何种原因的30天再入院风险均显著更高。
初级保健实践模式很复杂，受薪酬和组织结构的影响，这加强了进一步研究以增进我们对初级保健改革理解的必要性。此外，鉴于初级保健提供者日益短缺，COPD患者和其他慢性病患者尤其脆弱。
