A Comparison of Models of Primary Care Delivery in Winnipeg Alan Katz, Dan Chateau, Carole Taylor, Randy Walld, Scott McCulloch, Jeff Valdivia CAHSPR May 11, 2016 1 Manitoba Centre for Health Policy
Research Goal Compare/evaluate primary care quality indicators for five models of primary care delivery in Winnipeg Describe the impact of patient social complexity on primary care quality indicators and primary care provider panel size 2 Manitoba Centre for Health Policy
Methods Study period: April 1, 2010 to March 31, 2013 Describe and compare patients, primary care providers, and each model of primary care delivery 29 primary care quality indicators 3 Manitoba Centre for Health Policy
MCHP Houses the De-Identified Population Health Research Data Repository Families First Healthy Baby EDI Justice Hospital Physician Services Nursing Home Census Data at Area Level Social Housing Healthy Child MB Population-Based Health Registry Home Care Immunization Income Assistance Vital Statistics Family Services Pharmaceuticals K to Grade 12 Post-Secondary (UofM) Education CancerCare Medical Laboratory Health Surveys Clinical Emergency Department ICU FASD Pediatric Diabetes Cardiac Surgery 4 Manitoba Centre for Health Policy
Independent Variables Clinic characteristics Funding model (5 models) Traditional patient characteristics Age, sex, socio-economic status, chronic disease Primary care provider characteristics Age, sex, international medical graduate, years in practice Patient social complexities A new approach 5 Manitoba Centre for Health Policy
Models of Primary Care Characteristics 6 Manitoba Centre for Health Policy
Patient Allocation 12.2% 2.6% 1.9% 1.5% PIN FFS (n=76,261) WRHA Primary Care (n=16,536) Community Health Clinic (n=12,178) Teaching Clinic (n=9,526) 81.8% Non-PIN FFS (n=511,763) 7 Manitoba Centre for Health Policy
Primary Care Providers Table 3.2: Primary Care Provider Characteristics, by Model of Primary Care 2010/11 2012/13 Characteristics Provider Characterisitcs PIN FFS WRHA Primary Care Community Health Clinic Teaching Clinic Non-PIN FFS Number of Providers Count 83 58 64 37 448 International Medical Graduate (Physicians Only) Percent 23.2 18.2 10.9 22.9 50.3 Female Percent 43.4 72.4 73.4 40.5 35.9 Physicians Percent 100.0 70.7 70.3 94.6 98.9 Nurse Practitioner Percent 0.0 29.3 29.7 5.4 1.1 Provider Age Median 44.0 41.0 38.0 48.0 50.0 Years of Practice Median 5.8 3.7 3.3 4.7 10.4 Percentage of Non- Allocated Patient Visits Median 8.0 10.3 13.0 14.9 13.5 Full-Time Equivalent Median 1.0 0.3 0.3 0.5 1.0 8 Manitoba Centre for Health Policy
Age-Group Distribution 9 Manitoba Centre for Health Policy
Income Distribution 10 Manitoba Centre for Health Policy
Morbidity Level Distribution 11 Manitoba Centre for Health Policy
Prevention and Screening Indicator results * Compared to Non-PIN FFS 12 Manitoba Centre for Health Policy
Health Services Use and Delivery Table 9.7: Summary of Indicator Results by Model of Primary Care Compared to Non-PIN FFS: Health Indicator results Services Use and Delivery Model of Primary Care* Indicator PIN FFS WRHA Primary Care Community Health Clinic Teaching Clinic Continuity of Care, Assigned Primary Care Provider Hospitalizations for Ambulatory Care Sensitive Conditions, Aged 74 and Younger X-Ray for Lower Back Pain, Aged 20 and Older Hospital Episodes with a Readmission within 30 Days Emergency Department Visit Rate, Patients with CTAS 4 or 5 13 Manitoba Centre for Health Policy Ambulatory Visits to Primary Care Ambulatory Visits to Primary Care, Patients with RUB 3, 4 or 5 Ambulatory Visit with a Call to Health Links Info Santé within Two Days of Visit * indicates Compared that the to model Non-PIN of care rate/odds FFS ratio/index is statistically significantly higher than the rate/odds ratio/index for Non-PIN FFS model of care (p<0.01). indicates that the model of care rate/odds ratio/index is statistically significantly lower than the rate/odds ratio/index for Non-PIN FFS model of care (p<0.01). A blank cell represents no significant difference between the two models of primary care. *Full Adjusted Rate/Odds Ratio/Index: Adjusted for patient income quintile, sex, age, and RUB; and provider age, sex, years of practice, country of graduation (Canada or other); and social complexities.
Ambulatory Visits to Primary Care Annualized Crude Rates Model of Primary Care Total Visits RUB 3, 4, 5 3+ Social Complexities PIN FFS 4.39 5.45 5.26 WRHA Primary Care 3.72 4.72 4.49 Community Health Clinic 4.10 5.44 4.84 Teaching Clinic 3.84 4.88 4.91 Non-PIN FFS 4.58 5.97 5.63 Overall 4.51 5.84 5.52 14 Manitoba Centre for Health Policy
Limitations Administrative data lacks depth Limited to physician/nurse practitioner visit data No formal rostering The income data presented is ecological vs person level social complexities 15 Manitoba Centre for Health Policy
Conclusions The demographic of patients vary across different models of care No model of care does better than the others across all categories of indicators Room for improvement across all models of care 16 Manitoba Centre for Health Policy
Thank You / Questions umanitoba.ca/centres/mchp facebook.com/mchp.umanitoba https://twitter.com/um_mchp (@um_mchp) 17 Manitoba Centre for Health Policy