{"id":6502,"date":"2016-11-14T00:00:00","date_gmt":"2016-11-14T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada\/"},"modified":"2023-06-14T19:50:11","modified_gmt":"2023-06-14T23:50:11","slug":"those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada\/","title":{"rendered":"Those left behind from voluntary medical home reforms in Ontario, Canada"},"content":{"rendered":"<p><strong>Purpose<\/strong> &#x2014; Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes. <\/p>\n<p><strong>Methods <\/strong>&#x2014; We used administrative data to compare diabetes monitoring and cancer screening for patients attached to a medical home (N=10,785,687) versus a fee-for-service physician (N=1,321,800) in Ontario, Canada on March 31, 2011. We used Poisson regression to examine associations in 2011 after adjustment for patient factors and also assessed changes in outcomes between 2001 and 2011. <\/p>\n<p><strong>Results <\/strong>&#x2014; Patients attached to a fee-for-service physician were more likely to be immigrants and live in a low-income neighbourhood, and urban area. They were less likely to receive recommended testing for diabetes (25% vs. 34%; adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.73 to 0.75) and less likely to receive screening for cervical (52% vs. 66%; adjusted RR 0.79, 95% CI 0.79 to 0.79), breast (58% vs. 73%; adjusted RR 0.80, 95% CI 0.80 to 0.81), and colorectal cancer (44% vs. 62%; adjusted RR 0.72, 95% CI 0.71 to 0.72) compared to patients attached to a medical home physician in 2011. These differences in quality of care preceded medical home reforms. <\/p>\n<p><strong>Conclusion<\/strong> &#x2014; Patients left behind from medical home reforms are more likely to be poor, urban, and new immigrants and receive lower quality care. Strategies are needed to reach out to these patients and their physicians to reduce gaps in care.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Purpose &#x2014; Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes. Methods &#x2014; We used administrative data to compare diabetes monitoring and cancer screening [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[20,62,19,28],"migration-helper-qa-sample-set":[],"class_list":["post-6502","journal_article","type-journal_article","status-publish","hentry","topic-health-and-health-care-inequality","topic-health-services-research","topic-marginalized-populations","topic-primary-care"],"acf":{"citation":"Kiran T, Kopp A, Glazier RH. <em>Ann Fam Med<\/em>. 2016; 14(6):517:25.","source_url":"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5389393\/","ices_scientist":[1145,1250],"site":[6733],"research_program":[],"news_release":[7629],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[15712],"downloads":null,"links":null,"sitecore_item_id":"542A87A4-079D-4959-8DA2-9282B3177500","sitecore_item_name":"Those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada","sitecore_field_values":"{\n  \"__Valid from\": \"20170811T152709\",\n  \"Title\": \"Those left behind from voluntary medical home reforms in Ontario, Canada\",\n  \"Short title\": \"Those left behind from voluntary\",\n  \"Summary\": \"One in six patients in Ontario does not belong to an organized primary care practice.\",\n  \"Citation\": \"<p>Kiran T, Kopp A, Glazier RH. <em>Ann Fam Med<\/em>. 2016; 14(6):517:25.<\/p>\",\n  \"Abstract\": \"<p><strong>Purpose<\/strong> &mdash; Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes. <\/p>n<p><strong>Methods <\/strong>&mdash; We used administrative data to compare diabetes monitoring and cancer screening for patients attached to a medical home (N=10,785,687) versus a fee-for-service physician (N=1,321,800) in Ontario, Canada on March 31, 2011. We used Poisson regression to examine associations in 2011 after adjustment for patient factors and also assessed changes in outcomes between 2001 and 2011. <\/p>n<p><strong>Results <\/strong>&mdash; Patients attached to a fee-for-service physician were more likely to be immigrants and live in a low-income neighbourhood, and urban area. They were less likely to receive recommended testing for diabetes (25% vs. 34%; adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.73 to 0.75) and less likely to receive screening for cervical (52% vs. 66%; adjusted RR 0.79, 95% CI 0.79 to 0.79), breast (58% vs. 73%; adjusted RR 0.80, 95% CI 0.80 to 0.81), and colorectal cancer (44% vs. 62%; adjusted RR 0.72, 95% CI 0.71 to 0.72) compared to patients attached to a medical home physician in 2011. These differences in quality of care preceded medical home reforms. <\/p>n<p><strong>Conclusion<\/strong> &mdash; Patients left behind from medical home reforms are more likely to be poor, urban, and new immigrants and receive lower quality care. Strategies are needed to reach out to these patients and their physicians to reduce gaps in care.<\/p>n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5389393\/\" title=\"opens external link\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{713DC61D-206F-4E9B-8C00-D4EB3CA7BAB4}|{C854EE01-6CCA-41CE-9A24-52AA5AFA4C3F}|{F52AE291-FA47-48CD-836B-020B1B98C101}|{404E8236-468F-4DA1-8BA1-F405AC36275E}\",\n  \"Related Products\": \"<h2>News release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=BF5C55B1815643A6B4E12635B4EEBCF7&amp;_z=z\">Patients not attached to new primary care practices receive lower quality care, research suggests <\/a><\/h3>rn<h2>Research Video Series<\/h2>rn<h3><a href=\"https:\/\/www.youtube.com\/watch?v=QQK3lWMU4jA\" title=\"External link opens in new window\" target=\"_blank\">Tara Kiran on barriers to primary care reform for vulnerable patients<\/a><\/h3>\",\n  \"Research Programs\": \"{5B1AF319-EC9B-4BF0-A9CD-D066ABE49D71}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{EEDD5AB8-0E9D-4DBC-B5C7-7B4472AEC20A}|{2C81C93C-B401-432B-8741-83841744D4CA}\",\n  \"Posted Date\": \"20161114T102500\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2016\/January\/Those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Those left behind from voluntary medical home reforms in Ontario, Canada<\/title>\n<meta name=\"description\" content=\"Purpose &#x2014; Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/those-left-behind-from-voluntary-medical-home-reforms-in-ontario-canada\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Those left behind from voluntary medical home reforms in Ontario, Canada\" \/>\n<meta property=\"og:description\" content=\"Purpose &#x2014; Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. 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