Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
BMC Fam Pract. 2011 Jun 3;12:44. doi: 10.1186/1471-2296-12-44.
Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.
This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal) and chronic disease management (diabetes, heart failure, asthma).
Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms). In other cases it was improving in relation to previous measures (colorectal cancer screening). There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN.
Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.
加拿大安大略省的初级保健改革始于引入新的注册模式，其中两个最大的模式是家庭健康网络（FHNs），基于人头的模式，以及家庭健康小组（FHGs），混合的按服务收费模式。本研究的目的是评估 FHNs 和 FHG 之间的绩效差异，并比较医生加入这些新的初级保健团体前后的绩效。
本研究使用安大略省行政索赔数据比较了 FHG 和 FHN 的绩效指标。研究人群包括至少加入 FHN 或 FHG 两年的医生。如果患者在医生加入 FHN 或 FHG 后的两年内与医生注册，并且在医生加入 FHN 或 FHG 之前的两年内也见过医生，则将患者纳入分析。绩效是从行政数据中得出的，包括癌症（乳腺癌、宫颈癌、结直肠癌）和慢性病管理（糖尿病、心力衰竭、哮喘）的预防筛查措施。
两种模式之间的绩效指标并不一致。在某些情况下，绩效接近当前基准（巴氏涂片、乳房 X 光检查）。在其他情况下，与以前的措施相比，它正在改善（结直肠癌筛查）。加入 FHN 或 FHG 后，宫颈癌或乳腺癌筛查没有变化。FHNs 和 FHGs 中均增加了结直肠癌筛查。加入 FHG 或 FHN 后，糖尿病护理的处方绩效指标有所改善。然而，加入 FHG 或 FHN 后，年轻的糖尿病患者的年度眼部检查减少了。加入 FHG 或 FHN 后，心力衰竭管理或哮喘护理的绩效指标没有变化。
在人们加入后，预防筛查和糖尿病管理方面的一些改善可能归因于 FHG 和 FHNs 中向医生提供的激励性支付。然而，为了更具体地描述模型交付和激励措施的哪些方面影响护理，这些初级保健交付模式需要与其他交付模式和按服务收费实践进行比较。
