Simon Berthelot: The right care, for the right patient, at the right time, by the right provider: Value-based comparison of the management of ambulatory respiratory diseases in a primary care walk-in clinic and an emergency department

Introduction: The priorities in many Canadian health regions regarding primary care support the hypothesis that family medicine clinics offer equivalent medical care at a lower cost to ambulatory emergency patients. To our knowledge, this affirmation has never been formally tested.

Objectives: We will compare the value of the care offered in emergency departments and primary care clinics for ambulatory patients suffering from an upper respiratory tract infection, pneumonia, acute exacerbation of asthma or COPD. Specific objectives will be to compare the following aspects for this clientele: 1) the cost of patient care and 2) the clinical performance of these two alternative resources.

Methods: We will perform an ambidirectional cohort study at the CHUL emergency department (77,000 consultations/year) and at the Cité Médicale walk-in clinic (30,000 consultations/year) in Quebec City. The study will be composed of: 1) a prospective cohort to validate the cost of care processes using a time-driven activity-based costing method; 2) a retrospective cohort of 950 patients comparing the emergency department and primary care through analysis of clinical and administrative databases. We will include the following patients: 1) aged 2 years and over; 2) ambulatory throughout the care episode; 3) consulting for the first time for their problem; 4) with a targeted diagnosis when leaving the emergency department or clinic; and 5) sent home for treatment. The primary outcomes for which we will compare the emergency department to primary care will be: 1) the average cost of care for respiratory diseases (globally and per disease); 2) the adjusted rate of return to any emergency department or family medicine clinic 72h after the initial visit (globally and per disease).

Perspective: Probing data generated by this program will help deciders to direct their ambulatory patients with respiratory diseases to the right resources.



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