PT  - JOURNAL ARTICLE
AU  - Rudoler, David
AU  - de Oliveira, Claire
AU  - Cheng, Joyce
AU  - Kurdyak, Paul
TI  - Payment incentives for community-based psychiatric care in Ontario, Canada
AID  - 10.1503/cmaj.160816
DP  - 2017 Dec 11
TA  - Canadian Medical Association Journal
PG  - E1509--E1516
VI  - 189
IP  - 49
4099  - http://www.cmaj.ca/content/189/49/E1509.short
4100  - http://www.cmaj.ca/content/189/49/E1509.full
SO  - CMAJ2017 Dec 11; 189
AB  - BACKGROUND: In September 2011, the government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients after discharge from a psychiatric hospital admission and to those with a recent suicide attempt. We evaluated whether these incentives affected supply of psychiatric services and access to care.METHODS: We used administrative data to capture monthly observations for all psychiatrists who practised in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to evaluate whether the incentives affected the quantity of eligible outpatient services delivered and the likelihood of receiving follow-up care.RESULTS: Among 1921 psychiatrists evaluated, implementation of the incentive payments was not associated with increased provision of follow-up visits after discharge from a psychiatric hospital admission (mean change in visits per month per psychiatrist 0.0099, 95% confidence interval [CI] −0.0989 to 0.1206; change in trend 0.0032, 95% CI −0.0035 to 0.0095) or after a suicide attempt (mean change −0.0910, 95% CI −0.1885 to 0.0026; change in trend 0.0102, 95% CI 0.0045 to 0.0159). There was also no change in the probability that patients received follow-up care after discharge (change in level −0.0079, 95% CI −0.0223 to 0.0061; change in trend 0.0007, 95% CI −0.0003 to 0.0016) or after a suicide attempt (change in level 0.0074, 95% CI −0.0094 to 0.0366; change in trend 0.0006, 95% CI −0.0007 to 0.0022).INTERPRETATION: Our results suggest that implementation of the incentives did not increase access to follow-up care for patients after discharge from a psychiatric hospital admission or after a suicide attempt, and the incentives had no effect on supply of psychiatric services. Further research to guide design and implementation of more effective incentives is warranted.See related articles at www.cmaj.ca/lookup/doi/10.1503/cmaj.170092 and www.cmaj.ca/lookup/doi/10.1503/cmaj.171126