Team-based care within community health centres in Ontario, Canada and the association with emergency department visits: a population-based retrospective study

BACKGROUND: Team-based care is a primary care model that involves collaborative care between primary care providers and other professional providers. In Ontario Canada, this model is delivered through Community Health Centres. The study objective was to identify if visits to different providers within Community Health Centres were associated with fewer emergency department visits. METHODS: We conducted a retrospective population-based, nested case-control study using healthcare data at ICES. We included adults receiving primary care at a Community Health Centre in Ontario between 2016 and 2018 and captured the outcome of emergency department visits between 2019 and 2020. Using the Generalized Estimating Equation (GEE) extension of the negative binomial regression model, we estimated the association between number of visits to seven different provider types within a Community Health Centre and number of emergency department visits, with adjustment for potential confounders. We defined team-based care as a visit to one of the providers in a group other than a primary care physician or nurse practitioner (i.e., mental health, diet and lifestyle education, community workers/ lay patient support, physical therapy, health promotion system navigation, foot care). We also calculated the ratio of observed-to-expected average emergency department visits per person. RESULTS: We identified 138,324 patients across 71 Community Health Centres, with 43% who received team-based care. We found that increased number of visits to any provider was associated with more emergency department visits. However, there were no significant differences between observed and expected number of emergency department visits for people who received care from different providers. CONCLUSIONS: Almost half of the adult Community Health Centre population received team-based care. Although some benefits of team-based care have been established in the literature, we did not find any associations between care received from individual team-based provider types with lower emergency department visits.