Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs. Preliminary observations suggest high satisfaction among patients, higher income and more gratifi cation for family physicians, and trends for more medical students to select careers in family medicine. Popular demand is resulting in expansion to 200 FHTs. We describe the development, implementation, reimbursement plan, and current status of this multidisciplinary model, relating it to the principles of the patient-centered medical home. We also identify its potential to provide an understanding of many aspects of primary care. 2011;9:165-171. doi:10.1370/afm.1228. Ann Fam Med INTRODUCTIONC anada, as does the United States, faces a crisis in primary care. In response, a number of primary care reform models have been developed across Canada during the past decade. Of these models, Ontario's Family Health Team (FHT) model, 1 begun in 2005, most closely mirrors the "Principles of the Patient-Centered Medical Home" as endorsed by the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association. 2 We briefl y described this model in an online publication in the New England Journal of Medicine 3 and now provide a more complete description of FHTs' implementation, how FHTs achieve the joint principles of the patient-centered medical home, 2 and how the payment model provides incentives to achieve patient care goals. We further provide early fi ndings of their potential impact and discuss applicability of the model for the United States.Little information exists about wide implementation of medical homes or of their effi cacy in improving patient and physician satisfaction, increasing effi ciency, reducing costs, and improving outcomes. We believe a description of the FHT model provides useful information for the United States as it moves toward primary care reform. IMPLEMENTATION OF THE FHT MODEL IN ONTARIOIn 1969 Canada adopted a universal fi rst dollar health insurance program funded jointly by the provinces and the federal government. Each province assumed responsibility for its own health care system according to national guidelines. During its initial years, Ontario's health care system seemed well-funded and worked to the satisfaction of most Ontarians. By the mid 1980s, however, family physicians, the only primary care physician specialty in Canada, began to struggle to meet demands of their practices, and physician shortages began to appear. Most physicians were in solo or small-group fee-for-service practices. 166 ONTA RIO' S FA MILY HE A LT H T E A M M ODELto provide more visits in the face of costs rising and incomes static or falling. Many physicians began to...

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Fecal incontinence is a socially disabling symptom for which rectosphincteric biofeedback has been reported to be dramatically effective. The most commonly employed biofeedback procedure incorporates three separate and potentially effective components: exercise of the external sphincter muscle, training in discrimination of rectal sensations, and training synchrony of the internal and external sphincter responses. This paper reports the results of single case experiments employed with eight incontinent patients to examine the contributions of each of these components. All eight patients improved, but only one required the biofeedback procedure as it was originally described. Three responded to sensory discrimination training, one to exercise training, and one to the training of synchronous sphincteric responses; three recovered independently of the effects of biofeedback. Despite the achievement of continence, the rectosphincteric reflexes following treatment continued to be abnormal in every case. These findings suggest that the character of the external sphincter response to rectal distension is an unreliable index of sphincter function and that exercise and sensory discrimination training procedures are effective for some cases of fecal incontinence.

This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged.

This qualitative study examined medical students' and family practice residents' ideas, perceptions, and experiences of being mentored and their expectations of the mentoring experience. Eight focus groups and 16 individual interviews were used to collect data from 49 medical students and 29 family practice residents. Interviews and focus groups were audiotaped and transcribed verbatim. The analysis was iterative and interpretive, using both individual and team analyses. The analysis of the data revealed two central but related themes. The first theme reflected participants' overall experiences with mentors composed of three distinct elements: mentor roles (e.g. coach, advisor) and attributes (e.g. openness and approachability), interactions with mentors, and early exposure to family practice mentors (e.g. observing patient encounters). The second theme explicated the trainees' specific learning needs to be addressed by mentors that were categorised into three distinct yet overlapping levels: 1 practice level (i.e. guidance regarding the logistics of practice management) 2 system level (i.e. knowledge about the medical community as well as community resources) 3 personal level (i.e. guidance in balancing personal and professional responsibilities). Having the option of selecting multiple mentors to address unique aspects of the mentees' personal and professional development is critical in respecting the evolutionary nature and fluidity of the mentoring experience.