title: Quality of asthma care under different primary care models in Canada: a population-based study.
abstract: BACKGROUND
  Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models.
  
  
  METHODS
  Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators.
  
  
  RESULTS
  All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group.
  
  
  CONCLUSIONS
  Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. teresa.to@sickkids.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. teresa.to@sickkids.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. teresa.to@sickkids.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. teresa.to@sickkids.ca.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada. jun.guan@ices.on.ca.
authors.forename: Jun
authors.initials: J
authors.lastname: Guan
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. jingqin.zhu@sickkids.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. jingqin.zhu@sickkids.ca.
authors.forename: Jingqin
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Medicine, Queen's University, Kingston, Canada. lougheed@KGH.KARI.NET.|ICES - Queen's, Kingston, Canada. lougheed@KGH.KARI.NET.
authors.forename: M Diane
authors.initials: MD
authors.lastname: Lougheed
authors.affiliation: Family Physician Airways Group of Canada, Warwick, Canada. for4kids@gmail.com.
authors.forename: Alan
authors.initials: A
authors.lastname: Kaplan
authors.affiliation: Stonegate Community Health Centre, Toronto, Canada. itamar.tamari@stonegatechc.org.
authors.forename: Itamar
authors.initials: I
authors.lastname: Tamari
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada. matthew.stanbrook@uhn.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. matthew.stanbrook@uhn.ca.|Toronto Western Research Institute, University Health Network, Toronto, Canada. matthew.stanbrook@uhn.ca.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Stanbrook
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. jacqueline.simatovic@sickkids.ca.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Simatovic
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. l.feldman@mail.utoronto.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. l.feldman@mail.utoronto.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. Andrea.gershon@ices.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. Andrea.gershon@ices.on.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Andrea.gershon@ices.on.ca.|Sunnybrook Health Sciences Centre, Toronto, Canada. Andrea.gershon@ices.on.ca.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002170:Canada; D002204:Capitation Fee; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D018588:Fee-for-Service Plans; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care; D013147:Spirometry / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D005938:Glucocorticoids