Randomized controlled trial analysis: results for outcomes 1-year postindex date through generalized estimating equations
| Measure* | Mean estimate (CI) | p value | ||
|---|---|---|---|---|
| Intervention group n = 82 | Control group n = 74 | Relative difference† | ||
| Acute hospital admissions, mean per patient-year | 0.49 (0.28–0.87) | 0.34 (0.18–0.65) | 1.43 (0.61–3.38) | 0.413 |
| Emergency department visits, mean per patient-year | 0.94 (0.61–1.44) | 0.93 (0.59–1.45) | 1.02 (0.55–1.88) | 0.963 |
| Costs, mean $ per patient-year | 19 619 (15 368–25 046) | 15 424 (11 927–19 946) | 1.27 (0.89–1.81) | 0.184 |
| 30-day hospital readmissions, rate per 100 discharges‡ | 28.13 (14.63–54.05) | 25.00 (11.92–52.44) | 1.13 (0.42–3.02) | 0.815 |
| 7-day follow-up with family physician rate per 100 discharges‡ | 53.13 (33.03–85.46) | 21.43 (9.63–47.70) | 2.48 (0.98–6.29) | 0.056 |
Note: CI = confidence interval.
↵* Definitions of outcomes:
Acute hospital admissions included all urgent acute hospital admissions taking place during the 1-year pre- or postindex period (Discharge Abstract Database [DAD] data).
All causes of hospital admission were included, except for external causes of hospital admission or where the admission category was for newborns or stillbirths. Only the first separation in a hospital episode was considered (i.e., transfers were excluded).
Emergency department visits included all unplanned visits to an Ontario emergency department during the 1-year pre- or postindex period that did not result in an inpatient stay (National Ambulatory Care Reporting System data). All acuity levels were considered and patients were limited to 1 visit per day.
Cost included all health care expenditures that have been allocated to patient encounters for health care in the 1-year pre- or postindex period.1 Costs are in Can$2018.
Out-of-pocket expenses or insurance compensation paid out by third-party payers are not considered in this costing methodology.
Thirty-day readmissions included all index acute hospital admissions where the patient was discharged during the 1-year pre- or postindex period (DAD data). Index hospital admissions were excluded if the patient died in hospital, was discharged against medical advice or if the discharge date was in the last 30 days of the pre- or postindex period (to allow for complete follow-up). For each index event, we followed the patient prospectively for 30 days to identify any urgent inpatient readmissions for any cause.
Seven-day primary care follow-up included all index acute hospital admissions where the patient was discharged during the 1-year pre- or postindex period (DAD data).
Index hospital admissions were excluded if the patient died in hospital, was discharged against medical advice or if the discharge date was in the last 7 days of the pre- or postindex period (to allow for complete follow-up). For each index event, we followed the patient prospectively for 7 days to identify whether a visit to a primary care physician occurred (Ontario Health Insurance Plan and ICES Physician Database data).
↵† Relative difference is the ratio of the intervention group mean estimate to the control group mean estimate.
↵‡ Sample size: intervention = 16, control = 17. Sample for this outcome only includes those participants who had hospital discharge in the period 1 year following their index date.