ICES | Primary Care Models in Ontario English - page 15

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10
Ontario Drug Benefit Program (ODB)
The ODB program provides drug benefits for
all adults aged 65 and older and those
receiving social assistance in Ontario. The
ODB was used to determine the proportion of
patients on social assistance—welfare
(Ontario Works) and disability (Ontario
Disability Support Program)—who had
received a prescription under the plan within
the study period. Low-income seniors aged
65 and older were identified in the ODB using
a means test. The proportion of low-income
seniors was identified as the number of
low-income seniors who filled a prescription
divided by the total number of seniors. People
on social assistance and low-income seniors
would be under counted in these databases
as they only include those who filled a
prescription.
Client Agency Program Enrolment
(CAPE) Tables
This information source was used to identify
which patients had enrolled in which model
with which physicians over time. A separate
file provided by the Ministry of Health and
Long-Term Care identified the physicians that
were part of a FHT.
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ICES
Rurality Index of Ontario (RIO)
Urban-rural residential location was
assessed using the RIO. This index is widely
used as an aid to define rural areas. It was
recently updated with 2006 Canadian census
information. These updates have also
included changes to the methodology to
increase the stability of the RIO.
17
Those with
a RIO score of 0–39 were considered urban
and those with a RIO of 40 and above were
considered rural. These measures were used
to stratify the results, as demographics,
patterns of morbidity and ED use are known
to vary by urban-rural location.
Census of Canada
Data from the most recent Census of Canada
(May 2006) were provided by Statistics
Canada. The census takes place every five
years in Canada and is a reliable source of
information for population and dwelling
counts, as well as demographic and other
socioeconomic characteristics. For this study,
the main data element used was income
quintile, a measure of relative household
income adjusted for household size and
community. Roughly 20% of Ontarians fall into
each income quintile, with quintile 1 having
the lowest income and quintile 5 the highest.
Income quintile was derived by linking the
six-digit postal code of residence to census
data at the smallest possible level
(dissemination area), using the Postal Code
Conversion File Plus (PCCF+).
18
CASE MIX
Both the Johns Hopkins Adjusted Clinical
Group (ACG) methodology, as well as disease
cohorts, were used as measures of case mix.
ACGs are used to measure patient illness
burden.
19
The system estimates the illness
burden of individual patients and, when
aggregated across individuals, of populations.
The ACG methodology is one of several
diagnosis-based risk adjustment systems
developed to predict utilization of medical
resources, and is based on the fact that
patients who have certain groups of
diagnoses tend to have similar health care
utilization patterns. Patients using the most
health care resources are not typically those
with single diseases but rather those with
multiple and sometimes unrelated conditions.
This clustering of morbidity is a better
predictor of health care utilization than the
presence of specific diseases.
20
In the United
States, ACGs are able to explain more than
50% of same-year resource use by
individuals. Similar predictive ability has been
reported in Canada.
21
In contrast, age and sex
only explain approximately 10% of the
variation in resource use and cost.
21,22
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