title: Team-based innovations in primary care delivery in Quebec and timely physician follow-up after hospital discharge: a population-based cohort study.
abstract: BACKGROUND
  Outpatient follow-up has been a key intervention point in addressing gaps in care after hospital discharge. We sought to estimate the association between enrolment in new team-based primary care practices and 30-day postdischarge physician follow-up among older patients and patients with chronic illnesses who were admitted to hospital in Quebec, Canada.
  
  
  METHODS
  Patients were selected into this cohort if a primary care physician enrolled them as a "vulnerable patient" between November 2002 and January 2005. Data for this analysis included province-wide health insurance claims for inpatient and outpatient services delivered between November 2002 and January 2009 in Quebec. The primary analysis examined time to the first outpatient postdischarge follow-up service provided by either a primary care physician or a medical specialist. We used marginal structural models to estimate adjusted rates of follow-up with a primary care physician or with a medical specialist by primary care delivery models.
  
  
  RESULTS
  We extracted billing data for 312 377 patients that represented 620 656 index admissions for any cause from 2002 to 2009. Rates of 30-day follow-up were 374 visits to primary care physicians and 422 visits to medical specialists per 1000 discharges. Rates of primary care physician follow-up were similar across primary care delivery models, except for patients with very high morbidity; these patients had significantly higher rates of follow-up with a primary care physician if they were enrolled in team-based primary care practices (30-d rate difference [RD] 13.3 more follow-up visits per 1000 discharges, 95% confidence interval [CI] 6.8 to 19.8). Rates of follow-up with a medical specialist were lower among patients enrolled in team-based practices, particularly within 15 days of hospital discharge (15-d RD 25.1 fewer follow-up visits per 1000 discharges, 95% CI 21.1 to 29.1).
  
  
  CONCLUSIONS
  Our study found lower rates of postdischarge follow-up with a medical specialist among older patients and patients with chronic illness who were enrolled in team-based primary care practices compared with those enrolled in traditional primary care practices. Future research is needed to better understand the role of primary health care service organization in improving acute postdischarge care.
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Bruno D
authors.initials: BD
authors.lastname: Riverin
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Patricia
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Ashley I
authors.initials: AI
authors.lastname: Naimi
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Diop
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Provost
authors.affiliation: Department of Epidemiology (Riverin, Li, Diop, Strumpf), Biostatistics & Occupational Health, McGill University; Department of Pediatrics (Riverin, Li), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.; Department of Epidemiology (Naimi), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Penn.; Direction de la santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal (Diop, Provost, Strumpf); Centre de recherche du Centre Hospitalier de l'Université de Montréal (Provost); Institut de recherche en santé publique de l'Université de Montréal (Strumpf); Department of Economics (Strumpf), McGill University, Montréal, Que.
authors.forename: Erin
authors.initials: E
authors.lastname: Strumpf