Models of Primary Care Service Delivery in Ontario: Why Such Diversity?

Muldoon, Laura; Rowan, Margo; Geneau, Robert; Hogg, William; Coulson, David P.

doi:10.1016/s0840-4704(10)60240-2

Cited by 29 publications

(22 citation statements)

References 5 publications

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“…1 FHTs evolved from several earlier Ontario pilots, among which are Community Health Centers (CHCs), Family Health Networks (FHNs), and Family Health Groups (FHGs). 10 CHCs, originating in 1980, are more likely to serve rural, low-income, or minority populations. Physicians are reimbursed by salary, and practices are likely to have multidisciplinary teams.…”

Section: Implementation Of the Fht Model In Ontariomentioning

confidence: 99%

Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home

Rosser¹,

Colwill²,

Kasperski³

et al. 2011

The Annals of Family Medicine

138

114

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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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Section: Implementation Of the Fht Model In Ontariomentioning

confidence: 99%

Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home

Rosser¹,

Colwill²,

Kasperski³

et al. 2011

The Annals of Family Medicine

138

114

View full text Add to dashboard Cite

show abstract

“…The study was designed to describe and compare the structure and process of care within 4 primary health care delivery models in Ontario, Canada: fee for service (FFS), family health networks (FHNs), health service organizations (HSOs), and community health centers (CHCs). 11 From 2004 through 2006 practices operating within these 4 models were responsible for delivering primary care to most of the Ontario population. Table 1 displays these models, as well as the family health groups (FHGs) to which most practices in the FFS group eventually transitioned, and their essential characteristics.…”

Section: Delivering Chronic Dise a Se Managementmentioning

confidence: 99%

“…9 There are, however, important variations in the delivery of chronic disease management programs and services in primary care. 10,11 Recent studies suggest that the way chronic disease management is delivered in general practice is highly infl uenced by organizational factors. 12,13 Various studies have suggested that highquality chronic disease management can be promoted by fi nancial incentives, capitated payment structures, improved Internet technology infrastructure, and the wider use of nonmedical health care professionals.…”

mentioning

confidence: 99%

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Russell¹,

Dahrouge²,

Hogg³

et al. 2009

The Annals of Family Medicine

157

143

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PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identifi ed which practice organizational factors were independently associated with high-quality care. METHODSWe undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identifi ed those organizational factors independently associated with chronic disease management. RESULTSChronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONSThe study adds to the literature supporting the value of nursepractitioners within primary care teams and validates the contributions of Ontario's CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patientphysician ratios may have unanticipated negative effects on processes of care quality. 2009;7:309-318. doi:10.1370/afm.982. Ann Fam Med INTRODUCTIONC hronic health conditions are a substantial challenge to global health.1 By 2020 they will account for 73% of all deaths and 60% of the global burden of disease.2-5 Canada's experience matches that of much of the developed world, where in the next decade deaths caused by chronic diseases will increase by 15%. 6 The growing burden of chronic diseases threatens the sustainability of health care systems. 7,8 In the United States, for example, the annual economic effect on the US economy of the most common chronic diseases is more than $1 trillion and could reach nearly $6 trillion by the middle of the century. 4 Canada stands to lose $9 billion in the next decade from premature deaths caused by heart disease, stroke, and diabetes. Policy makers have become increasingly interested in the potential of high-quality primary care to help deal with the chronic disease challenge. Primary care is well positioned to have an important impact on outcomes of care for patients with chronic conditions. 9 The...

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“…The models vary by funding structure, but also by organizational structure and stated priorities. 11 We conducted this study to compare the delivery of preventive services by practices in the four funding models and to identify organizational factors associated with superior preventive care. This study is part of a larger evaluation of primary care models in Ontario funded by the Ontario Ministry of Health and Long-Term Care through its Primary Health Care Transition Fund.…”

mentioning

confidence: 99%

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Dahrouge

Hogg

Russell

et al. 2011

CMAJ

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P rimary care providers are increasingly in terested in ensuring that preventive health care be part of their work routines.1 This reorientation fits with the evidence that recommendations from family practitioners increase substantially the likelihood of patients undergoing preventive manoeuvres, 2 whereas the lack of such recommendations has been linked with patient noncompliance. 3,4 Studies evaluating adherence to recommended preventive care suggest that the most pervasive barriers rest with the organization of the health care system and the practice itself, such as the absence of external financial incentives for the work done and the lack of a reminder system in the office. 3,5−9 Countries attempting to reform their delivery of primary care and improve the delivery of preventive services have often directed their efforts in finding alternatives to the traditional fee-forservice model, in which providers receive payment for each service provided. There are two predominant alternative funding models: capitation (pro viders receive a fixed lump-sum payment per pa tient per period, independent of the number of services performed) and salaried remuneration. Some health care systems blend components of fee for service with either of these models or offer additional incentives for reaching defined qualityof-care targets. Despite considerable rhetoric, there is little evidence to point to the remuneration models associated with superior delivery of primary care services. 10 The complexity of health

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Models of Primary Care Service Delivery in Ontario: Why Such Diversity?

Cited by 29 publications

References 5 publications

Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home

Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

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