Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
Department of Economics, University of Ottawa, Ottawa, Ontario, Canada.
Can J Diabetes. 2021 Apr;45(3):261-268.e11. doi: 10.1016/j.jcjd.2020.09.002. Epub 2020 Sep 8.
In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.
Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from FHG to FHO on 8 quality indicators related to diabetes care. Because FHO physicians are likely to be systematically different from FHGs, we employed propensity-score-based inverse probability-weighted fixed-effects regression models. All analyses were conducted at the physician level.
We found that FHO physicians were more likely to provide glycated hemoglobin testing by 2.75% (95% confidence interval [CI], 1.89% to 3.60%), lipid assessment by 2.76% (CI, 1.95% to 3.57%), nephropathy screening by 1.08% (95% CI, 0.51% to 1.66%) and statin prescription by 1.08% (95% CI, 0.51% to 1.66%). Patients under FHOs had a lower estimated risk of mortality by 0.0124% (95% CI, 0.0123% to 0.0126%) per physician per year. However, FHG and FHO physicians were similar for annual eye examination, prescription of angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers) and patients' risk of avoidable diabetes-related hospitalizations.
Compared with blended fee-for-service, blended capitation payment is associated with a small, but statistically significant, improvement in some aspects of diabetes care.
在 21 世纪中后期，加拿大安大略省的许多家庭医生从家庭健康小组（混合按服务项目收费模式）转为家庭健康组织（混合人头付费模式）。文献中关于医生薪酬方案与糖尿病护理质量之间联系的证据参差不齐。我们研究了与仍留在家庭健康小组模式的医生相比，从家庭健康小组转为家庭健康组织模式的医生是否为糖尿病患者提供了更好的护理。
使用 2006 年至 2016 年的纵向健康管理数据，我们调查了医生从家庭健康小组转为家庭健康组织对 8 项与糖尿病护理相关的质量指标的影响。由于家庭健康组织的医生可能与家庭健康小组存在系统差异，因此我们采用倾向评分匹配逆概率加权固定效应回归模型。所有分析均在医生层面进行。
我们发现，家庭健康组织的医生更有可能进行 2.75%的糖化血红蛋白检测（95%置信区间，1.89%至 3.60%）、2.76%的血脂评估（95%置信区间，1.95%至 3.57%）、1.08%的肾病筛查（95%置信区间，0.51%至 1.66%）和 1.08%的他汀类药物处方（95%置信区间，0.51%至 1.66%）。每位医生每年使患者的死亡率估计风险降低 0.0124%（95%置信区间，0.0123%至 0.0126%）。然而，家庭健康小组和家庭健康组织的医生在每年的眼部检查、血管紧张素转换酶抑制剂（或血管紧张素Ⅱ受体阻滞剂）的处方以及患者避免糖尿病相关住院治疗的风险方面并无差异。
与混合按服务项目收费相比，混合人头付费与某些方面的糖尿病护理略有但具有统计学意义的改善相关。
