Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study

Comprehensive primary care may enhance patient experience at end of life.

To examine whether belonging to different models of primary care is associated with end-of-life healthcare use and outcomes.

Retrospective population cohort study, using health administrative databases to describe health services and costs in the last six months of life across three primary care models: enrolled to a physician remunerated mainly by capitation, with incentives for comprehensive care and access in some to allied health practitioners (Capitation); remunerated mainly from fee-for-service (FFS) with smaller incentives for comprehensive care (Enhanced FFS); and not enrolled, seeing physicians remunerated solely through FFS (Traditional FFS).

People who died from April 1, 2010 to March 31, 2013 in Ontario, Canada.

Health service utilization, costs, and place of death.

Approximately two-thirds (62.7%) of decedents had more contact with a specialist than family physician. Those in Capitation models were more likely to have the majority of physician services provided by a family physician (44.9% vs. 38.6% in Enhanced FFS and 34.3% in Traditional FFS) and received more home care service days (mean 27.2 vs. 24.2 in Enhanced FFS and 21.7 in Traditional FFS). And 22.5% had a home visit by a family physician. Controlling for potential confounders, decedents spent significantly more days in an institution in Enhanced FFS (1.1, 95% confidence interval [CI]: 0.9-1.5) and Traditional FFS (2.2, 95% CI: 1.8-2.6) than in Capitation.

Decedents in comprehensive primary care models received more care in the community and spent less time in institutions.