{"id":13222,"date":"2023-01-17T00:00:00","date_gmt":"2023-01-17T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/publications\/journal-articles\/effect-of-a-multimorbidity-intervention-on-health-care-utilization-and-costs-in-ontario-randomized-controlled-trial-and-propensity-matched-analyses\/"},"modified":"2023-07-19T15:49:27","modified_gmt":"2023-07-19T19:49:27","slug":"effect-of-a-multimorbidity-intervention-on-health-care-utilization-and-costs-in-ontario-randomized-controlled-trial-and-propensity-matched-analyses","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/effect-of-a-multimorbidity-intervention-on-health-care-utilization-and-costs-in-ontario-randomized-controlled-trial-and-propensity-matched-analyses\/","title":{"rendered":"Effect of a multimorbidity intervention on healthcare utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing healthcare utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched).<\/p>\n<p><strong>Methods<\/strong> \u2014 Data for 82 RCT intervention and 74 RCT control participants were linked with health administrative data. We created a second control group using health administrative data\u2013derived propensity scores to match (1:5) intervention participants with comparators. We evaluated 5 outcomes: acute hospital admissions, emergency department visits, costs of all insured healthcare, 30-day hospital readmissions and 7-day family physician follow-up after hospital discharge using generalized linear models for RCT controls and generalized estimating equations for propensity-matched controls.<\/p>\n<p><strong>Results<\/strong> \u2014 There were no significant differences between intervention participants and either control group. For hospital admissions, emergency department visits, costs and readmissions, the relative differences ranged from 1.00 (95% confidence interval [CI] 0.39\u20132.60) to 1.67 (95% CI 0.82\u20133.38) with intervention costs at about Can$20 000, RCT controls costs at around Can$15 000 and propensity controls costs at around Can$17 000. There was a higher rate of follow-up with a family physician for the intervention participants compared with the RCT controls (53.13 v. 21.43 per 100 hospital discharges; relative difference 2.48 [95% CI 0.98\u20136.29]) and propensity-matched controls (49.94 v. 28.21 per 100 hospital discharges; relative difference 1.81 [95% CI 0.99\u20133.30]).<\/p>\n<p><strong>Interpretation<\/strong> \u2014 Despite a complex patient-centred intervention, there was no significant improvement in healthcare utilization or cost. Future research requires larger sample sizes and should include outcomes important to patients and the healthcare system, and longer follow-up periods.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing healthcare utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched). Methods \u2014 Data for 82 RCT [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[42,61],"migration-helper-qa-sample-set":[],"class_list":["post-13222","journal_article","type-journal_article","status-publish","hentry","topic-chronic-diseases-and-multimorbidity","topic-health-economics"],"acf":{"citation":"Ryan BL, Mondor L, Wodchis WP, Glazier RH, Meredith L, Fortin M, Stewart M. <em>CMAJ Open<\/em>. 2023; 11(1):E45-53. Epub 2023 Jan 17.","source_url":"https:\/\/www.cmajopen.ca\/content\/11\/1\/E45","ices_scientist":[1335,1135,1250,1369,16470],"site":[6733],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"975166CC-88E5-4107-A4A1-B764C1258C9B","sitecore_item_name":"Effect-of-a-multimorbidity-intervention-on-health-care-utilization-and-costs-in-Ontario","sitecore_field_values":"{\r\n  \"Title\": \"Effect of a multimorbidity intervention on healthcare utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses\",\r\n  \"Short title\": \"Effect of a multimorbidity intervention\",\r\n  \"Summary\": \"The authors conducted a RCT comparing healthcare utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched).\",\r\n  \"Citation\": \"<p>Ryan BL, Mondor L, Wodchis WP, Glazier RH, Meredith L, Fortin M, Stewart M. <em>CMAJ Open<\/em>. 2023; 11(1):E45-53. Epub 2023 Jan 17. DOI: <a href=\"https:\/\/doi.org\/10.9778\/cmajo.20220006\" title=\"opens external link\">https:\/\/doi.org\/10.9778\/cmajo.20220006<\/a><\/p>\",\r\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing healthcare utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched).<\/p>n<p><strong>Methods<\/strong> &mdash; Data for 82 RCT intervention and 74 RCT control participants were linked with health administrative data. We created a second control group using health administrative data&ndash;derived propensity scores to match (1:5) intervention participants with comparators. We evaluated 5 outcomes: acute hospital admissions, emergency department visits, costs of all insured healthcare, 30-day hospital readmissions and 7-day family physician follow-up after hospital discharge using generalized linear models for RCT controls and generalized estimating equations for propensity-matched controls.<\/p>n<p><strong>Results<\/strong> &mdash; There were no significant differences between intervention participants and either control group. For hospital admissions, emergency department visits, costs and readmissions, the relative differences ranged from 1.00 (95% confidence interval [CI] 0.39&ndash;2.60) to 1.67 (95% CI 0.82&ndash;3.38) with intervention costs at about Can$20 000, RCT controls costs at around Can$15 000 and propensity controls costs at around Can$17 000. There was a higher rate of follow-up with a family physician for the intervention participants compared with the RCT controls (53.13 v. 21.43 per 100 hospital discharges; relative difference 2.48 [95% CI 0.98&ndash;6.29]) and propensity-matched controls (49.94 v. 28.21 per 100 hospital discharges; relative difference 1.81 [95% CI 0.99&ndash;3.30]).<\/p>n<p><strong>Interpretation<\/strong> &mdash; Despite a complex patient-centred intervention, there was no significant improvement in healthcare utilization or cost. Future research requires larger sample sizes and should include outcomes important to patients and the healthcare system, and longer follow-up periods.<\/p>n<p><a href=\"https:\/\/www.cmajopen.ca\/content\/11\/1\/E45\" title=\"opens external link\">View full text<\/a><\/p>\",\r\n  \"ICES Scientists\": \"{35559122-CE0A-4CBE-8B27-2C74786FF830}|{26C6C411-14DA-4E2F-9D10-9564115ADE0A}|{2C81C93C-B401-432B-8741-83841744D4CA}|{46CDAA96-34C5-48B5-ADA6-0EC8DBE9ED03}\",\r\n  \"Posted Date\": \"20230117T000000\",\r\n  \"Show on Publications Landing Page\": \"1\"\r\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2023\/January\/Effect-of-a-multimorbidity-intervention-on-health-care-utilization-and-costs-in-Ontario"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Effect of a multimorbidity intervention on healthcare utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses<\/title>\n<meta name=\"description\" content=\"Background \u2014 Patients with multimorbidity require coordinated and patient-centred care. 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