Browsing by Author "Souri, Sepideh"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    A comparison between alternative primary care physician payment models: A systematic review and policy analysis
    (2020-09-24) Souri, Sepideh; McBrien, Kerry Alison; Chuck, Anderson W.; Manns, Braden J.; Quinn, Amity E.
    Objective: Alternative models of primary care physician payment are being considered by policy-makers as a potential way to contain healthcare expenditures. The purpose of this thesis was to synthesize the evidence for alternative primary care physician payment models on quality and economic outcomes worldwide and to make recommendations with respect to payment models that may improve chronic disease management in Canada. Methods: We first conducted a systematic review, searching selected databases from inception to October 2018, for studies that compared primary care physician payment models. There were no restrictions on language, country, or publication date, however studies were restricted to specific study designs (randomized controlled trial, controlled cohort and interrupted time series). A gray literature search was also conducted. The outcomes considered were quality and access to care, patient and physician satisfaction, clinical outcomes, healthcare utilization and costs. Thirteen studies were selected for synthesis, comparing fee-for-service, capitation, incentive payments, and mixed models. We then identified primary care payment methods currently used in Canada through an environmental scan. We applied evidence from the systematic review to evaluate the impact of the three most promising models on quality, utilization, cost, and implementation feasibility, and made a recommendation. Conclusion: Primary care payment models have moved toward incentive payments and mixed models in recent years, and mixed models have promising effects on cost and utilization overall and for managing chronic disease in primary care in Canada. Incentive payments show low sustainability in quality improvements, and a gap in incentivized and non-incentivized aspects of care. Mixed models have been introduced in primary care in Canada. Based on current evidence, the recommended payment model for Canadian primary care physicians that is most likely to optimize chronic disease management is blended capitation. Future studies should focus on long-term quality improvements and improving the quality of non-incentivized activities in incentive models. Further study would help to elucidate the potential benefit of mixed models, in particular their effect on patient-oriented aspects of care: access, continuity, and quality. More studies are needed to understand how blended capitation payment models affect costs and utilization.
  • Thumbnail Image
    ItemOpen Access
    Cost-effectiveness analysis of a randomized study of depression treatment options in primary care suggests stepped-care treatment may have economic benefits
    (2019-08-05) Yan, Charles; Rittenbach, Katherine; Souri, Sepideh; Silverstone, Peter H
    Abstract Background The stepped-care pathway (SCP) model has previously been found to be clinically effective for depressive disorder in some studies, but not all. Several groups have suggested that a stepped-care approach is the most appropriate in primary care. There is relatively little information, however, regarding which specific stepped-care pathway may be best. This analysis aimed to determine cost-effectiveness of a stepped-care pathway for depression in adults in primary care versus standard care (SC), treatment-as-usual (TAU), and online cognitive behavioural therapy (CBT). Methods We conducted a randomized trial with 1400 participants and 12-week follow-up to assess the impact of the four treatment options on health-related quality of life and depression severity. Costs for the groups were calculated on the basis of physician, outpatient, and inpatient services using administrative data. We then calculated the incremental cost-effectiveness ratios using this information. Cost-effectiveness acceptability curves and incremental cost-effectiveness scatterplots were created using Monte Carlo simulation with 10,000 replications. A subgroup analysis was conducted for participants who screened as depressed at baseline. Results For all participants, TAU was the most expensive followed by CBT, SC, and SCP. QALYs were highest in SCP, followed by SC, CBT, and TAU. In the depressed subgroup, TAU was still the most expensive, followed by SC, SCP, and CBT, while QALYs were still highest in SCP, followed by SC, CBT, and TAU. The cost-effectiveness acceptability curves suggested that SCP had a higher probability for cost-effectiveness than the other three alternatives in all participants. In the depressed subgroup, CBT was associated with the highest probability of cost-effectiveness for a willingness-to-pay cut-off of less than approximately $50,000, while SCP was the highest at a cut-off higher than $50,000. There is considerable uncertainty around the cost-effectiveness estimates. Conclusions Our analysis showed that even where there are no clinically significant differences in health outcomes between treatment approaches, there may be economic benefit from implementing the stepped-care model. While more work is required to identify the most clinically effective versions of a stepped-care pathway, our findings suggest that the care pathway may have potential to improve health care system value. Trial registration NCT01975207 . The trial was prospectively registered on 4 November 2013.
  • Thumbnail Image
    ItemOpen Access
    Identification of validated case definitions for chronic disease using electronic medical records: a systematic review protocol
    (2017-02-23) Souri, Sepideh; Symonds, Nicola E; Rouhi, Azin; Lethebe, Brendan C; Garies, Stephanie; Ronksley, Paul E; Williamson, Tyler S; Fabreau, Gabriel E; Birtwhistle, Richard; Quan, Hude; McBrien, Kerry A
    Abstract Background Primary care electronic medical record (EMR) data are being used for research, surveillance, and clinical monitoring. To broaden the reach and usability of EMR data, case definitions must be specified to identify and characterize important chronic conditions. The purpose of this study is to identify all case definitions for a set of chronic conditions that have been tested and validated in primary care EMR and EMR-linked data. This work will provide a reference list of case definitions, together with their performance metrics, and will identify gaps where new case definitions are needed. Methods We will consider a set of 40 chronic conditions, previously identified as potentially important for surveillance in a review of multimorbidity measures. We will perform a systematic search of the published literature to identify studies that describe case definitions for clinical conditions in EMR data and report the performance of these definitions. We will stratify our search by studies that use EMR data alone and those that use EMR-linked data. We will compare the performance of different definitions for the same conditions and explore the influence of data source, jurisdiction, and patient population. Discussion EMR data from primary care providers can be compiled and used for benefit by the healthcare system. Not only does this work have the potential to further develop disease surveillance and health knowledge, EMR surveillance systems can provide rapid feedback to participating physicians regarding their patients. Existing case definitions will serve as a starting point for the development and validation of new case definitions and will enable better surveillance, research, and practice feedback based on detailed clinical EMR data. Systematic review registration PROSPERO CRD42016040020