Dataset Information

Explaining primary care physicians' decision to quit patient-centered medical homes: Evidence from Quebec, Canada.

ABSTRACT:

Objective

To examine the factors explaining primary care physicians' (PCPs) decision to leave patient-centered medical homes (PCMHs).

Data sources

Five-year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group.

Study design

We use fixed-effects and random-effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness of our results using survival analysis, one lag in the regressions and focusing on a matched sample of quitters and stayers.

Data collection/extraction methods

We extract information from Quebec's universal health insurer billing data on all the PCPs who joined a PCMH between 2003 and 2005, supplemented by information on their elderly and chronically ill patients.

Principal findings

About 17 percent of PCPs leave PCMHs within 5 years of follow-up. Physicians' demographics have little influence. However, those with more complex patients and higher revenues are less likely to leave the medical homes. These findings are robust across a variety of specifications.

Conclusion

As expected, higher revenue favors retention. Importantly, our results suggest that PCMH may provide appropriate support to physicians dealing with complex patients.

SUBMITTER: Ammi M

PROVIDER: S-EPMC6407354 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Explaining primary care physicians' decision to quit patient-centered medical homes: Evidence from Quebec, Canada.

Ammi Mehdi M Diop Mamadou M Strumpf Erin E

Health services research 20190206 2

<h4>Objective</h4>To examine the factors explaining primary care physicians' (PCPs) decision to leave patient-centered medical homes (PCMHs).<h4>Data sources</h4>Five-year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group.<h4>Study design</h4>We use fixed-effects and random-effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness ...[more]

PMID: 30729507

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Project description:BackgroundThere is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the quality and efficiency outcomes associated with this transition.ObjectiveTest quality and efficiency outcomes associated with 2-year transition to PCMH status among physicians in intervention versus control practices.DesignRandomized Controlled Trial.ParticipantsEighteen intervention practices with 43 physicians and 14 control practices with 24 physicians; all from adult primary care practices.InterventionsModeled on 2008 NCQA PPC®-PCMH™, intervention practices received 18 months of tailored practice redesign support; 2 years of revised payment, including up to $2.50 per member per month (PMPM) for achieving quality targets and up to $2.50 PMPM for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.Main measuresEleven clinical quality indicators from the 2009 HEDIS process and health outcomes measures derived from patient claims data; Ten efficiency indicators based on Thomson Reuter efficiency indexes and Emergency Department (ED) Visit Ratios; and a panel of costs of care measures.Key resultsCompared to control physicians, intervention physicians significantly improved TWO of 11 quality indicators: hypertensive blood pressure control over 2 years (intervention +23 percentage points, control -2 percentage points, p =0.02) and breast cancer screening over 3 years (intervention +3.5 percentage points, control -0.4 percentage points, p =0.03). Compared to control physicians, intervention physicians significantly improved ONE of ten efficiency indicators: number of care episodes resulting in ED visits was reduced (intervention -0.7 percentage points, control + 0.5 percentage points, p = 0.002), with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant cost-savings on any of the pre-specified costs of care measures.ConclusionsIn a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over 2 years, although most indicators did not improve and there were no cost-savings compared with control practices. For the most part, quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial.

Project description:BackgroundFor more than a decade, the Patient-Centered Medical Home model has been a guiding vision for the modernization of primary care systems. In Canada, Ontario's Family Health Teams (FHTs) were designed in the mid-2000s with the medical home model in mind. These primary care clinics aim to provide accessible, comprehensive, and person-centered primary care services to communities across Ontario. Their services typically include mental health care for people experiencing common mental disorders, such as depression and anxiety disorders. It remains unclear, however, whether the mental health care delivered within FHTs is consistent with person-centered care approaches. In the current study, we aimed to explore the perspectives of FHT providers on the care delivered to people with common mental disorders to determine whether, and to what extent, they believed this care was person-centered.MethodsWe conducted a qualitative grounded theory study involving interviews with 65 health professionals and administrators from 18 FHTs across Ontario. Transcripts were coded using a three-step process of initial, focused, and axial coding that mixed inductive and deductive approaches informed by sensitizing concepts on person-centeredness.ResultsPractices and challenges associated with the delivery of mental health care in a person-centered way were captured by several themes regrouped into five domains: (1) patient as unique person, (2) patient-provider relationship, (3) sharing power and responsibility, (4) connecting to family and community, and (5) creating person-centered care environments. FHT providers perceived that they delivered person-centered care by delivering mental health care that was responsive, flexible, and consistent with biopsychosocial approaches. They emphasized the importance of creating long-lasting relationships with patients grounded in empathy and trust. Their challenges included being able to ensure continuity of care, adequately prioritizing patients' mental health issues, and meaningfully engaging patients and families as partners in care.ConclusionsOur findings suggest that FHT providers have adopted a range of person-centered practices for people with common mental disorders. However, greater attention to practices such as shared decision making, supporting self-management, and involving families in care would strengthen person-centeredness and bring teams closer to the Patient-Centered Medical Home vision.

Dataset Information

Explaining primary care physicians' decision to quit patient-centered medical homes: Evidence from Quebec, Canada.

Objective

Data sources

Study design

Data collection/extraction methods

Principal findings

Conclusion

Publications

Explaining primary care physicians' decision to quit patient-centered medical homes: Evidence from Quebec, Canada.

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