Grant: Travel Awards - Institute Community Support

There is tremendous pressure on healthcare systems to meet the demands of chronic diseases care, while containing costs. Various financial incentives have been recently introduced to promote interprofessional and organizational collaboration across the health system. In Ontario, Canada, bundled payment models were piloted in three health centres for the management of patients hospitalized for congestive heart failure (CHF). These models offered prospective payments covering disease-specific management and coordination in acute and home care settings for 30 days but do not include primary or specialist care in their coverage. There are two main challenges with designing bundled payments for chronic disease such as CHF, which our study will aim to address: 1) selecting the appropriate services to include in the bundle after hospitalization; 2) determining whether the integration of these services in the episode of care improves patient outcomes such as readmission and mortality rates. This study will follow a prospective cohort of patients hospitalized for CHF in Ontario, Canada, from April 1st, 2012 to March 31st, 2016. The index event will be the first hospital discharge experienced by a patient, which will trigger the bundled care services. Patients will be followed for up to 2 years after the conclusion of their first bundled episode. The main exposures will be whether patients received a bundled care episode with different service components including: 1) primary care follow up within 7 days of discharge; 2) home care services within 21 days; 3) access to an outpatient cardiologist within 30 days of discharge. Categorized by different combination of service components, our analysis will examine the risk adjusted 30-day and 1-year mortality rates and all-cause hospitalization in patients. The results of this study will help support future discussions on the feasibility of extending existing bundled payments for individuals living with CHF, in Ontario, Canada.