Evidence map›Paper›PMID 36649982›Full record

Trial reportCMAJ open

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

Bridget L Ryan, Luke Mondor, Walter P Wodchis, Richard H Glazier, Leslie Meredith, Martin Fortin, Moira Stewart

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Bridget L RyanCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont. bryan@uwo.ca.
Luke MondorCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
Walter P WodchisCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
Richard H GlazierCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
Leslie MeredithCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
Martin FortinCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
Moira StewartCentre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing health care utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched).

methodsData for 82 RCT intervention and 74 RCT control participants were linked with health administrative data. We created a second control group using health administrative data-derived propensity scores to match (1:5) intervention participants with comparators. We evaluated 5 outcomes: 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 using generalized linear models for RCT controls and generalized estimating equations for propensity-matched controls.

resultsThere were no significant differences between intervention participants and either control group. For hospital admissions, emergency department visits, costs and readmissions, the relative differences ranged from 1.00 (95% confidence interval [CI] 0.39-2.60) to 1.67 (95% CI 0.82-3.38) with intervention costs at about Can$20 000, RCT controls costs at around Can$15 000 and propensity controls costs at around Can$17 000. There was a higher rate of follow-up with a family physician for the intervention participants compared with the RCT controls (53.13 v. 21.43 per 100 hospital discharges; relative difference 2.48 [95% CI 0.98-6.29]) and propensity-matched controls (49.94 v. 28.21 per 100 hospital discharges; relative difference 1.81 [95% CI 0.99-3.30]).

interpretationDespite a complex patient-centred intervention, there was no significant improvement in health care utilization or cost. Future research requires larger sample sizes and should include outcomes important to patients and the health care system, and longer follow-up periods. ONTARIO: ClinicalTrials.gov : 104191.

Indexed as

MultimorbidityPatient Acceptance of Health CareHospitalizationHospitalsHumansOntario

Identifiers

PMID36649982
PMCPMC9851625

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.