Did changing primary care delivery models change performance? A population based study using health administrative...

Area of Science:

• Health Services Research
• Primary Care Policy
• Health Outcomes

Background:

• Ontario implemented primary care reforms introducing Family Health Networks (FHNs) and Family Health Groups (FHGs).
• FHNs operate on a capitation model, while FHGs use a blended fee-for-service approach.
• This study evaluates physician and patient performance within these new primary care models.

Purpose of the Study:

• To compare the performance of Family Health Networks (FHNs) and Family Health Groups (FHGs).
• To assess changes in care quality before and after physician enrollment in these models.
• To identify specific performance measures affected by primary care reform in Ontario.

Main Methods:

• Utilized Ontario administrative claims data for comparative analysis.
• Included physicians in FHNs or FHGs for at least two years.
• Analyzed patient data from periods before and after physician enrollment, focusing on preventive screenings and chronic disease management.

Main Results:

• Performance varied across different measures and models; no consistent differences were found between FHNs and FHGs.
• Colorectal cancer screening rates increased in both models.
• Improvements were noted in diabetes care prescribing, but annual eye exams decreased for younger diabetic patients. No changes observed in heart failure or asthma care.

Conclusions:

• Incentive payments within FHGs and FHNs may contribute to observed improvements in screening and diabetes care.
• Further comparative studies are necessary to understand the specific impacts of delivery models and incentives on patient care.
• The study highlights the need for nuanced evaluation of primary care reforms.