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Characteristic Enhanced fee-for-service model Capitation model Patient enrolment Optional Required After-hours call Required Required Fee-for-service payment Full payment plus 10% premium for 21 comprehensive care services Payment at 10% of full rate for 56 services for enrolled patients; established maximum fee-for-service payments annually Extended hours One 3-hr evening or weekend session per physician per wk, to a maximum of 5 sessions; exempted if > 50% of physicians provide emergency, anesthesia or obstetrics coverage Same as enhanced fee-for-service model After-hours care Additional 20% of fee-for-service payment for enrolled and virtually enrolled patients for 9 basic office services Same as enhanced fee-for-service model Access bonus NA Additional payment, reduced if enrolled patient sees an nonspecialist physician outside of group Group management and leadership NA Annual fee per enrolled patient Management of care for heart failure Annual fee per enrolled patient for coordinating, providing and documenting required elements of care for heart failure Same as enhanced fee-for-service model Unattached patient fee A one-time fee for enrolling an acute care patient without a family physician following discharge from an inpatient hospital stay Same as enhanced fee-for-service model New patient premium A one-time fee for up to 60 enrolled new patients without a family physician; increase in fee for patients aged 65–74 yr, and a further increase in fee for patients aged 75 yr and over Same as enhanced fee-for-service model Note: NA = not applicable.
Variable No. of patients (%)*
n = 14 907Patient characteristics Age, yr; mean ± SD 65.2 ± 15.9 Male 7 942 (53.3) Income quintile 1 2 491 (16.7) 2 2 893 (19.4) 3 2 913 (19.5) 4 3 198 (21.5) 5 3 412 (22.9) Rural residence 2 088 (14.0) Long-term care or nursing home residence 248 (1.7) Immigrant 1 195 (8.0) Past medical history Hypertension, recent diagnosis (in the last yr) 419 (2.8) Hypertension, diagnosis made before the last 1 yr 8 699 (58.4) Heart failure, recent diagnosis (in the last yr) 225 (1.5) Heart failure, diagnosis made before the last 1 yr 787 (5.3) Acute myocardial infarction 2 156 (14.5) Coronary artery disease 1 726 (11.6) Coronary artery bypass graft 361 (2.4) Stroke 541 (3.6) Diabetes mellitus 2 896 (19.4) Dementia 550 (3.7) Chronic obstructive pulmonary disease 2 426 (16.3) Asthma 2 014 (13.5) Renal failure 527 (3.5) Nonmetastatic cancer 1 895 (12.7) Metastatic cancer 252 (1.7) CHADS2 score ≥ 2 5 830 (39.1) ADG score, mean ± SD 9.9 ± 4.2 Emergency department visit characteristics Emergency department triage score (1 = highest acuity) 1 or 2 9 916 (66.5) 3 4 991 (33.5) No. of patients who arrived by ambulance 4 074 (27.3) Time of day patient presented to emergency department 00:00–07:59 2 872 (19.3) 08:00–15:59 7 640 (51.3) 16:00–23:59 4 395 (29.5) Day of week patient presented to emergency department Weekday 11 492 (77.1) Weekend 3 415 (22.9) Emergency department physician, sex Unknown 1 895 (12.7) Female 2 581 (17.3) Male 10 431 (70.0) Emergency department physician, specialty Emergency medicine (3-yr program) 5 875 (39.4) Emergency medicine (5-yr program) 1 962 (13.2) Family medicine 3 832 (25.7) Other 1 345 (9.0) Unknown 1 893 (12.7) Emergency department physician, no. of years of practice; yr 0–3 1 900 (12.7) 4–10 3 686 (24.7) 11–20 4 219 (28.3) > 20 3 159 (21.2) Unknown 1 943 (13.0) Hospital type Community 11 285 (75.7) Small 836 (5.6) Teaching 2 786 (18.7) Family physician characteristics Family physician, sex Female 3 804 (25.5) Male 10 333 (69.3) Unknown 770 (5.2) Family physician, main specialty Family medicine 13 981 (93.8) Emergency medicine 146 (1.0) Unknown 780 (5.2) Family physician, no. of years of practice; yr 0–5 542 (3.6) 6–10 901 (6.0) 11–15 1 353 (9.1) > 15 11 329 (76.0) Unknown 782 (5.2) No. of patients with a family physician 14 146 (94.9) Family physician’s model type CCM† or FHG‡ 6 613 (44.4) FHN§ with FHT 692 (4.6) FHN§ without FHT 315 (2.1) FHO¶ with FHT 2 271 (15.2) FHO¶ without FHT 3 189 (21.4) FFS** 1 066 (7.2) Family physician belongs to an FHT 2 963 (19.9) Note: ADG = aggregated diagnosis group, CCM = comprehensive care model, CHADS2 = cardiac failure, hypertension, age, diabetes, stroke system, FFS = fee for service, FHG = family health group, FHN = family health network, FHO = family health organization, FHT = family health team, SD = standard deviation. *Unless otherwise specified. †Primarily fee for service, < 3 physicians. ‡Primarily fee for service, ≥ 3 physicians. §Primarily capitation, small basket of services. ¶Primarily capitation, large basket of services. **Traditional fee for service.
- Table 3: Follow-up care among patients (n = 14 907) discharged from an emergency department in Ontario with a new diagnosis of atrial fibrillation
Time to follow-up care, d Total no. of patients seen (%) No. of patients with follow-up care from family physician only (%) No. of patients with follow-up care from cardiologist or internist only (%) No. of patients with follow-up care from cardiologist or internist, with or without family physician (%) No. of patients with follow-up care from both family physician and cardiologist or internist (%) No. of patients with follow-up care from any of family physician, cardiologist or internist (%) No. of patients who died after discharge Within 3 d Within 7 d Within 30 d 1–3 4 085 (27.4) 3 094 (20.8) 787 (5.3) 991 (6.7) 204 (1.4) 4 085 (27.4) 14 21 61 1–7 7 473 (50.1) 5 311 (35.6) 1 414 (9.5) 2 162 (14.5) 748 (5.0) 7 473 (50.1) 14 34 97 1–30 12 229 (82.0) 6 473 (43.4) 1 765 (11.8) 5 756 (38.6) 3 991 (26.8) 12 229 (82.0) 14 34 120 > 30 2 678 (18.0) – – – – – 6 14 24 - Table 4: Adjusted odds of obtaining follow-up care from a family doctor, cardiologist or internist within 7 days of emergency department discharge among patients who had a family physician (n = 14 146)
Variable OR (95% CI) p value Patient characteristics Age, per decade increase 1.09 (1.06–1.12) < 0.001 Female 1.05 (0.98–1.13) 0.18 Income quintile; referent = 1, lowest 2 1.07 (0.96–1.20) 0.22 3 1.04 (0.93–1.16) 0.53 4 0.95 (0.85–1.06) 0.34 5 (highest) 1.05 (0.94–1.17) 0.40 Rural residence 0.95 (0.85–1.07) 0.44 Long-term care or nursing home residence 0.77 (0.56–1.05) 0.09 Immigrant 1.18 (1.04–1.34) 0.01 Past medical history; referent = 0 Hypertension, recent diagnosis (in the last yr) 1.14 (0.92–1.40) 0.23 Hypertension, diagnosis made before the last 1 yr 1.15 (1.06–1.26) 0.002 Heart failure, recent diagnosis (in the last yr) 0.87 (0.65–1.14) 0.31 Heart failure, diagnosis made before the last 1 yr 0.75 (0.64–0.88) < 0.001 Acute myocardial infarction 1.02 (0.92–1.14) 0.68 Coronary artery disease 0.83 (0.73–0.94) 0.003 Coronary artery bypass graft 1.09 (0.85–1.40) 0.49 Stroke 0.78 (0.65–0.94) 0.01 Diabetes mellitus 1.06 (0.96–1.17) 0.24 Dementia 0.84 (0.69–1.03) 0.09 Chronic obstructive pulmonary disease 1.03 (0.93–1.13) 0.58 Asthma 1.04 (0.94–1.15) 0.44 Renal failure 0.69 (0.57–0.83) < 0.001 Nonmetastatic cancer 0.84 (0.76–0.94) 0.002 Metastatic cancer 0.94 (0.72–1.22) 0.62 CHADS2 score ≥ 2; referent = 0 or 1 0.97 (0.87–1.09) 0.65 ADG score per 1 point increase 1.04 (1.03–1.05) < 0.001 Emergency department visit characteristics Emergency department triage score of 1 or 2 (high acuity); referent = 3, 4 or 5 1.02 (0.94–1.09) 0.69 Patients who arrived by ambulance 0.99 (0.91–1.07) 0.77 Time of day patient presented to the emergency department 00:00–07:59 0.89 (0.81–0.98) 0.01 16:00–23:59 0.93 (0.86–1.00) 0.05 Day of week patient presented to the emergency department, weekend 0.94 (0.87–1.03) 0.17 Emergency department physician, age per decade increase 0.97 (0.84–1.12) 0.62 Emergency department physician, female 1.06 (0.93–1. 20) 0.34 Emergency department physician, main specialty;
referent = family medicine trainingEmergency medicine (3-yr program) 0.90 (0.76–1.05) 0.16 Emergency medicine (5-yr program) 0.91 (0.75–1.10) 0.29 Other 0.93 (0.57–1.53) 0.73 Emergency department physician, no. of years of practice; yr 4–10 1.03 (0.91–1.16) 0.38 11–20 0.98 (0.83–1.15) 0.85 > 20 0.98 (0.73–1.30) 0.86 Hospital type; referent = community Small 0.82 (0.69–0.98) 0.03 Teaching 1.16 (1.04–1.29) 0.007 Family physician characteristics Family physician, age per decade increase 1.00 (0.99–1.00) 0.24 Family physician, female 0.99 (0.91–1.07) 0.82 Family physician, no. of years of practice; yr 6–10 1.02 (0.82–1.27) 0.83 11–15 1.07 (0.87–1.31) 0.54 > 15 1.06 (0.86–1.29) 0.59 Family physician, reimbursement type CCM* or FHG†; referent FHN‡ with FHT 0.73 (0.62–0.86) < 0.001 FHN‡ without FHT 0.77 (0.60–0.97) 0.03 FHO§ with FHT 0.84 (0.76–0.93) < 0.001 FHO§ without FHT 0.86 (0.79–0.94) 0.001 FFS¶ 0.94 (0.82–1.07) 0.33 Note: ADG = aggregated diagnosis group, CCM = comprehensive care model, CHADS2 = cardiac failure, hypertension, age, diabetes, stroke system, CI = confidence interval, FFS = fee for service, FHG = family health group, FHN = family health network, FHO = family health organization, FHT = family health team, OR = odds ratio, SD = standard deviation. *Primarily fee for service, < 3 physicians. †Primarily fee for service, ≥ 3 physicians. ‡Primarily capitation, small basket of services. §Primarily capitation, large basket of services. ¶Traditional fee for service.
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