Table 196 Annual per capita costs - entire trial

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Table 196 Annual per capita costs - entire trial Powered By Docstoc
					Table 196 Annual per capita costs – entire trial


                                                        Intervention         Control
                                                        participants       participants
 MBS                                                        1,294             1,038
 DI                                                          616               597
 PBS                                                        1,787             1,716
 Inpatient hospital                                         3,514             3,269
 Total (Services)                                           7,211             6,620
 Care Coordination activities                                605
 Total (Services and care co-ordination)                    7,816              6,620


Table 196 indicates the following:

•	        Inpatient costs are higher for the intervention group than the control group; this is largely driven by the
          experience, observed above, for the period surrounding trial start-up.

•	        Intervention participants had higher per capita cost than control participants during this period before the
          cost of care coordination was included. After care coordination was included the annual per capita cost rate
          was higher for intervention participants than control participants.

•	        As previously noted, there was evidence to suggest that the trial was not in operation for long enough
          for intervention participants to have a lower total cost than control participants, suggesting that the care
          coordination is not absorbed initially but potentially absorbed in latter time periods.

Table 197 presents a comparison of per capita rates in the 6 to 18 months post-trial commencement.

Table 197 Annual per capita costs – 6 to 18 months post-commencement


                                                         Intervention          Control
                                                         participants        participants
 MBS                                                         1,220              1,048
 DI                                                           596                605
 PBS                                                         1,783              1,742
 Inpatient hospital                                          3,438              3,694
 Total (Services)                                            7,036              7,088
 Care Coordination activities                                 605
 Total (Services and care co-ordination)                     7,641               7,088




Page 472 | The Team Care Health II (TCHII)
Table 197 indicates the following:

•	      Intervention participants had slightly lower per capita cost than control participants over this period
        before the cost of care coordination was included (this was not the case when the entire trial period was
        considered). After care coordination is included the annual per capita cost rate is higher for intervention
        participants than control participants.

•	      These per capita rates further support the argument that care coordination was not absorbed initially but
        may be absorbed in later time periods.

Overall, it is difficult to determine whether care coordination was absorbed due to a small sample size (indicated
by the power calculations) and because the trial was not in progress for long enough. However, there is some
support for the argument that care coordination was not absorbed initially but may be absorbed in latter time
periods.

The following sections analyse MBS, DI, PBS and inpatient service utilisation separately.

5.2.2 MBS service utilisation and cost

This section inc1ludes the following:

a statistical comparison of control and intervention participants for both MBS services and co2rends in the most
common broad type of services.

Statistical comparison of control and intervention participants by quarter

Table 198 presents a statistical comparison of the control and intervention groups. Statistical differences at the
90% level are shaded.

Table 198 Statistical comparison of MBS services and costs between control and intervention


                                          Pre-commencement                            Trial
                                                3-6      0-3      0-3      3-6      6-9        9-12     12-15     15-18
                Statistic                   months   months    months   months   months     months    months    months
MBS Services    Mean Control                   5.01     6.09     5.67     5.29     5.02        5.65      5.46      5.24
MBS Services    Mean Intervention              5.33     6.20     6.72     6.21     6.05        5.99      5.79      5.72
MBS Services    Difference                     0.32     0.11     1.04     0.91     1.02        0.35      0.33      0.47
MBS Services    SD Difference                  0.21     0.22     0.23     0.22     0.25        0.25      0.30      0.29
MBS Services    Z                              1.49     0.50     4.53     4.07     4.11        1.38      1.08      1.62
MBS Services    LCI90%                        -0.03    -0.26     0.67     0.54     0.61       -0.07     -0.17     -0.01
MBS Services    UCI90%                         0.66     0.48     1.42     1.28     1.43        0.76      0.83      0.96
MBS Services    p                           13.65%   61.71%    0.00%    0.00%    0.00%      16.77%    28.09%    10.61%

MBS Costs       Mean Control                214.37    280.32   259.97   245.74   234.99     280.22     271.70    259.29
MBS Costs       Mean Intervention           252.25    291.71   382.01   329.02   312.19     308.43     302.16    294.67
MBS Costs       Difference                   37.87     11.39   122.04    83.28    77.20      28.21      30.47     35.38
MBS Costs       SD Difference                13.35     16.34    15.80    15.07    17.66      17.69      20.84     20.30
MBS Costs       Z                             2.84      0.70     7.72     5.53     4.37       1.59       1.46      1.74
MBS Costs       LCI90%                       15.92    -15.48    96.05    58.50    48.15      -0.88      -3.81      1.99
MBS Costs       UCI90%                       59.83     38.26   148.02   108.07   106.24      57.30      64.74     68.77
MBS Costs       p                           0.45%    48.58%    0.00%    0.00%    0.00%     11.07%     14.38%     8.13%



The key features of Table 198 are:

•	      There was a statistical difference in the pre-commencement period between control and intervention.
        Intervention participants had insignificantly higher service utilisation and significantly higher cost. This was
        not expected due to the randomisation process in allocating participants between intervention and control.

•	      Intervention participants used more and cost significantly more in the first nine months after trial
        commencement compared with control participants. This presents evidence that an ‘intervention’ occurred
        with regards to an injection of MBS services.




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EPC item analysis

Table 199 compares EPC item utilisation pre-commencement and during the trial for intervention and control
participants.

Table 199 EPC items pre-commencement and during the trial – intervention and control


                                   Pre-
EPC Utilisation                commencement   Trial
Control                            0.09       0.10
Intervention                       0.09       0.39
EPC item utilisation was 9% for both intervention and control participants in the pre-commencement period.
Intervention participants had a significantly higher utilisation in the trial period compared with control participants,
demonstrating the attainment of one of TCHII’s objectives of using the EPC package.

Analysis of the trends in the most common broad type of services

Figure 21 and Figure 109 present service utilisation and cost on a PQ basis for the most common MBS broad types
of services accessed by trial participants. These are:

•	        unreferred attendances GP/VRGP;

•	        specialist attendances;

•	        operations; and

•	        EPC attendances.

Control and intervention participants were also compared.




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Figure 108 MBS services per PQ for control and intervention participants




                                                                           The Team Care Health II (TCHII) | Page 475
Figure 109 Cost of MBS services per PQ for control and intervention participants




Page 476 | The Team Care Health II (TCHII)
The key features of Figure 108 and Figure 109 are:
•	         an increase in GP services immediately preceding early trial; this is evident for both intervention
           and control participants;
•	         an increase in EPC items for intervention participants immediately following commencement,
           which is sustained throughout the trial; this was not the case for control participants; and

a decrease in operation costs for intervention participants during the trial.

5.2.3 DI service utilisation and cost

This section includes:
•	         a statistical comparison of control and intervention participants for both DI services and costs in each
           quarter; and

•	         an analysis of the trends in the most common broad type of services.

Statistical comparison of control and intervention participants by quarter

The following table presents a statistical comparison of the control and intervention groups. Statistical differences
at the 90% level are shaded.

Table 200 Statistical comparison of DI services and costs between control and intervention


                                            Pre-commencement                              Trial
                                                  3-6      0-3      0-3       3-6       6-9        9-12     12-15     15-18
                  Statistic                   months   months    months   months    months      months    months    months
DI Services       Mean Control                   4.31     5.30     4.66      4.75      4.67        5.10      5.14      4.75
DI Services       Mean Intervention              4.43     5.25     5.40      5.03      5.12        4.92      4.98      4.92
DI Services       Difference                     0.12    -0.05     0.74      0.28      0.44       -0.18     -0.16      0.17
DI Services       SD Difference                  0.25     0.27     0.27      0.27      0.33        0.32      0.39      0.38
DI Services       Z                              0.48    -0.19     2.74      1.04      1.36       -0.55     -0.41      0.44
DI Services       LCI90%                        -0.30    -0.50     0.29     -0.17     -0.09       -0.70     -0.80     -0.46
DI Services       UCI90%                         0.54     0.39     1.18      0.74      0.98        0.35      0.48      0.80
DI Services       p                           63.03%   84.68%    0.61%    30.03%    17.25%      58.07%    67.86%    65.64%

DI Costs          Mean Control                128.01    153.17   141.28    137.20    140.11     159.23     165.83    141.30
DI Costs          Mean Intervention           135.37    156.33   165.85    148.24    153.57     144.46     154.13    146.18
DI Costs          Difference                    7.36      3.16    24.57     11.05     13.46     -14.77     -11.70      4.87
DI Costs          SD Difference                 8.94      9.69     9.82      9.15     10.34      11.49      15.98     13.20
DI Costs          Z                             0.82      0.33     2.50      1.21      1.30      -1.29      -0.73      0.37
DI Costs          LCI90%                       -7.34    -12.78     8.42     -4.00     -3.55     -33.67     -37.98    -16.84
DI Costs          UCI90%                       22.05     19.11    40.72     26.10     30.47       4.13      14.58     26.59
DI Costs          p                          41.04%    74.41%    1.23%    22.72%    19.31%     19.86%     46.41%    71.20%


The key features of Table 200 are:
•	         There was no statistical difference between control and intervention participants in the pre-commencement
           period.
•	         Intervention participants had higher costs in the first three months after commencing the trial compared
           with control participants. This presents evidence that an ‘intervention’ occurred with regards to an injection
           of DI services.




                                                                                                                       The Team Care Health II (TCHII) | Page 477