Grant: Operating Grant

Reforms to Canadian primary health care have advanced at a rapid pace over the last decade, with the consistent goal of improving the efficiency of the health care system: that is, improving the health of individuals and populations at similar or lower costs. Only limited evidence on the impacts of these reforms currently exists, particularly with respect to utilization patterns, system costs, and health outcomes. In a previously CIHR-funded project, we are evaluating the impacts of the centerpiece of Quebec's primary care reforms - Family Medicine Groups (FMGs). A typical FMG consists of 6 to 10 physicians working with 2 nurses to provide services for 10,000 to 20,000 registered patients. Our initial results suggest that FMGs have little to no impact on emergency department use, hospitalizations, or costs over a 3-year period among elderly or chronically ill patients. These results raise questions about the impacts of FMGs at a more micro level. Specifically, do the aggregate impacts mask important differences among sub-populations or sub-types of health care services? Given FMGs focus on enhanced access and better coordination of care, impacts may be concentrated among certain types of patients and of services, in particular: 1. patients with multiple chronic diseases, who require more coordination across providers and settings to ensure high quality care and better health outcomes 2. preventive services including mammography, colonoscopy, and bone density screening tests, as well as annual major complete exams We propose evaluating the impacts of FMGs on utilization and costs among these patients and services, as well as investigating the effects on disease management and adherence to relevant clinical guidelines. A rigorous evaluation of the effects of FMGs on these particularly vulnerable patient groups and important preventive services will inform both whether and how interdisciplinary, team-based delivery models work in achieving their goals.