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Those left behind from voluntary medical home reforms in Ontario, Canada


Purpose — 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 — 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.

Results — 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.

Conclusion — 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.



Kiran T, Kopp A, Glazier RH. Ann Fam Med. 2016; 14(6):517:25.

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A new study led by Dr. Tara Kiran shows that patients who do not belong to an organized primary care practice receive lower quality care.

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