Background
Methods
Design
Sample
Community Health Centre (CHC) | Fee for service (FFS) | Family Health Network (FHN) | Health Service Organization (HSO) | ||
---|---|---|---|---|---|
Traditional Fee for Service | Family Health Groups (FHG)1
| ||||
Year introduced
| 1970s | - | 2004 | 2001 | 1970s |
Group size
| Groups practice - Unspecified size | 1 Physician | Minimum 3 | Minimum 3 | Minimum 3 |
Physician remuneration
| Salary | FFS | FFS and incentives | Capitation2 with a 10% FFS component, and incentives | Capitationb
and incentives |
Patient enrolment
| Required No roster size limit | Not required | Required No roster size limit | Required Disincentive to enrol >2,4003
| Required Disincentive to enrol >2,4003
|
Access
| No specified requirements | No specified requirements | THAS4
Extended hours5
| THAS Extended hours5
Access bonus6
| THAS Extended hours5
Access negation7
|
Multi-disciplinarity
8
| Significant | None | None | Some | Some |
Assistance for Information Technology
| Some | None | None | Yes | None |
Objectives/Priorities
| Responsiveness to population needs, multi-disciplinarity, prevention, focus on underserved, equity community governed | - | Accessibility | Accessibility, comprehensiveness, doctor-nurse collaboration, use of technology | Responsiveness to population needs, multi-disciplinarity, health promotion, cost effectiveness |
Data collection
Instruments
Performance measures
Quality of Health Care Service Deliverya (items in the scale, categories in the likert scale of each item) | Source of data | Overall score rangesc
| |
---|---|---|---|
Access |
First contact accessibility (4, 4)
| Patient survey | 74% - 83% |
First contact utilization (3, 4)
| Patient survey | 96% - 98% | |
Patient-Provider |
Humanism (8, 7)
| Patient survey | 90% - 91% |
Relationship |
Trust (10, 5)
| Patient survey | 87% - 88% |
Cultural competency (3, 4)
| Patient survey | 83% - 85% | |
Family centeredness (3, 4)
| Patient survey | 89% - 90% | |
Continuity |
Ongoing care (4, 4)
| Patient survey | 85% - 90% |
Technical Quality of Clinical Care Delivery
b
- Adherence to recommended guidelines (items in the scale) | |||
Health Promotion |
Healthy lifestyle counseling (7)
| Patient survey | 46% - 59% |
Prevention |
Preventive care (6)
| Chart audit | 52% - 68% |
Chronic Disease Management |
Chronic disease management (9)
| Chart audit | 60% - 72% |
Analysis
1. Identify gender differences
Survey patient profile | Men | Women |
---|---|---|
1 Socio-demographic and economic profile | ||
SE Age (mean‡, median in years) | 53/53 | 48/47 |
SE Household income (% under LICO)‡
| 13 | 19 |
SE Low education (% with less than high school degree) * | 19 | 16 |
SE Not speaking English or French at home (%) | 1.7 | 1.9 |
SE Aboriginal (%)* | 0.8 | 1.6 |
SE Uninsured (in Canada) (%) | 1.6 | 2.3 |
SE Not working outside the house (%) | 37 | 26 |
SE Recent immigrant (< 5 years) (%) | 2.0 | 2.5 |
SE Rurality index (mean) | 13 | 13 |
SE Distance from home to practice > 10 km (%) | 26 | 25 |
Health status
| ||
H At least one day with poor mental health in past 30 days (%)‡
| 34 | 49 |
H At least one day with poor physical health in past 30 days (%)‡
| 56 | 62 |
H At least one day limited by poor mental or physical health in past 30 days (%)* | 40 | 43 |
H Physical, mental or emotional problem lasting more than one year (%) | 43 | 41 |
H Self perceived health good-excellent (%) | 82 | 82 |
H Presence of at least one chronic disease/Number of chronic diseases (%) | 74/1.9 | 73/1.8 |
Relationship with the practice
| ||
Provider is a Nurse Practitioner (%)‡
| 2.1 | 7.5 |
Seeing their own provider at that visit (%) | 91.5 | 92.1 |
Attending the practice for more than 2 years (%) | 83 | 83 |
Number of visits to the office in previous year (mean†, median) | 5.8, 4 | 6.6,4 |
Main reason for visit - Check up/Chronic problem/Recent problem | 35/30/36 | 36/27/37 |
Chart audit patient profile
| ||
Uninsured in Ontario (%)* | 0.7 | 1.6 |
Age (mean‡, median in years) | 49.5/48 | 46.0/45 |
Number of visits to the office in previous year (mean‡, median) | 4.3/3 | 5.0/4 |