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Researchers find basic infrastructure already in place to build a better healthcare system in Ontario


Researchers at the Institute for Clinical Evaluative Sciences (ICES) identified 78 informal, multispecialty physician networks in Ontario. Such networks have been shown to achieve high quality, low cost care for chronic disease patients in other jurisdictions.

“The current healthcare structure and payment system in Ontario is focused on acute care and is poorly aligned with chronic disease patient needs. Serious quality gaps in providing chronic disease care are attributed to poor coordination among healthcare providers and fragmentation of care,” says Therese Stukel, lead author and scientist at ICES.

Chronic disease, including heart failure, coronary heart disease, asthma, chronic obstructive pulmonary disease and depression, is the leading cause of death in Canada. It affects more than 1 in 3 Canadians, has a huge impact on health and quality of life, and accounts for more than half of provincial healthcare spending.

Although care tends to be fragmented in Ontario ICES researchers were able to identify 78 informal multispecialty physician networks using health administrative data by linking patients to the physicians from whom they seek care and the hospitals where they are admitted. These networks are generally large and include multiple primary care physicians, specialists and at least one hospital. They were not constrained geographically. Virtually all Ontario residents and physicians were linked to a network, and most residents received most of their care from providers within their network.

The networks are not formally organized and providers are typically unaware that they are part of a network. However, physicians in such networks are associated by virtue of sharing care for common patients, admitting patients to the same hospitals, and sharing important resources that affect their patients’ outcomes.

“Such organic, self-organizing networks could form the basis of ‘systems of care’ that collectively serve their large panels of chronic disease patients, to provide a range of healthcare services, implement system improvements, and be held accountable for results,” says Stukel.

The researchers add that the study provides a snapshot of what the current system looks like in Ontario. Formalizing these multispecialty physician networks would foster accountability for efficient, integrated care through care management tools and quality improvement.

“These findings provide a theoretical basis to support the present move by the Ontario Ministry of Health and Long-term Care to form ‘Health Links’ in Ontario,” says David Henry, co-author of the paper and CEO at ICES.

Authors: Therese A. Stukel, Richard H. Glazier, Susan E. Schultz, Jun Guan, Brandon M. Zagorski, Peter Gozdyra and David A Henry.

The study “Multispecialty physician networks in Ontario,” was published today in Open Medicine.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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