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January 1, 2023CMAJ OpenOpen Access

Effect of a multimorbidity intervention on health care utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses

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Why the study?

Patients with multimorbidity require coordinated and patient-centred care, but the impact of interventions like Telemedicine IMPACT Plus on health care utilization and costs needed evaluation.

Does a coordinated team-based and patient-centred care intervention (Telemedicine IMPACT Plus) reduce health care utilization and costs in complex patients with multimorbidity?

Population

82 RCT intervention and 74 RCT control participants with multimorbidity in Toronto, Ontario

Comparison

Telemedicine IMPACT Plus vs RCT controls and 1:5 propensity-matched controls

Design

Randomized controlled trial and propensity-matched analyses

Follow-up

1-year postintervention

Authors

BRBridget RyanLMLuke MondorWWWalter P. Wodchis

Discussion

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Member takes

Overview

No reduction in utilization or costs with the intervention; challenges expectations for complex multimorbidity care and supports larger trials with patient-centered outcomes.

Structured PICO

Does a coordinated team-based and patient-centred care intervention (Telemedicine IMPACT Plus) reduce health care utilization and costs in complex patients with multimorbidity?

P
Population
156 adults (aged 18-80 years) with multimorbidity (≥3 chronic conditions) and high health care utilization, referred by provider. Excluded: cognitive impairment, illiterate, or previously received the intervention. Mean age 62.0, 64.6% female, based in Toronto, Ontario.
I
Intervention
Telemedicine IMPACT Plus (coordinated team-based and patient-centred care including a meeting with a nurse to elaborate goals, and a subsequent case conference of about 6 providers including the patient and family physician)
C
Comparator
Usual care within a primary care team-based model (RCT control) and propensity-matched controls derived from health administrative data
O
Outcome
5 outcomes evaluated: acute hospital admissions, emergency department visits, costs of all insured health care, 30-day hospital readmissions, and 7-day family physician follow-up after hospital discharge at 1-year postinterventionhard clinical

A complex patient-centred multimorbidity intervention did not significantly improve health care utilization or costs at 1 year compared to usual care.

Limitations

  • Small sample size
  • Unmeasured confounding in propensity match (e.g., lifestyle behaviours)
  • Propensity controls not subject to placebo effects
  • Controls could have been healthier due to exclusion of deaths within 1 year
  • Regression to the mean
  • Outcomes limited to hospital care and direct costs
  • 1-year follow-up may not be sufficiently long

Cite This Study

Ryan et al. (2023) studied this question.

synapsesocial.com/papers/6a9d2b5ec51d29f379efdcd3https://doi.org/10.9778/cmajo.20220006
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Assessing balance in measured baseline covariates when using many‐to‐one matching on the propensity‐score2008 · 187 citations
  2. 2An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies2011 · 12,429 citations
  3. 3Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study)2019 · 139 citations
  4. 4Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study2017 · 10 citations
  5. 5Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial2021 · 36 citations