Table 1.

Practice descriptions

CHARACTERISTICVICTORIA
(SITE 1)
WINNIPEG
(SITE 2)
TORONTO
(SITE 3)
VANCOUVER
(SITE 4)
TORONTO
(SITE 5)
Initiating factorFunding cuts to geriatric assessment servicesHigh hospital use and difficult dischargesHigh hospital use and difficult dischargesCommunity need of homebound patients with retiring physicianFunding cuts to home-care services for seniors
First year20032011201120082007
Performance metrics
  • ED visits

  • Hospital days

  • ED visits

  • Hospital days

  • ED visits

  • Hospital days

  • Deaths at home

  • Hospital admissions

  • Hospital days

Target patient population
  • Homebound

  • Age >75 y

  • Frail

  • Adults with high hospital use

  • Homebound

  • Age >65 y

  • Adults with high hospital use

  • Homebound

  • Age >80 y

  • Homebound

  • Age >65 y

  • Frail

Approximate panel size2808568400300
Referral source
  • Self-referrals

  • Home care, about 25%

  • Community physician, about 25%

  • Hospital

  • Home care

  • Local hospital

  • Home care

  • Local hospital

  • Home care

  • Hospital, 40%

  • Home care, 40%

  • Other, 20%

  • ED—emergency department.