title: Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention.
abstract: BACKGROUND
  We evaluated a large-scale transition of primary care physicians to blended capitation models and team-based care in Ontario, Canada, to understand the effect of each type of reform on the management and prevention of chronic disease.
  
  
  METHODS
  We used population-based administrative data to assess monitoring of diabetes mellitus and screening for cervical, breast and colorectal cancer among patients belonging to team-based capitation, non-team-based capitation or enhanced fee-for-service medical homes as of Mar. 31, 2011 (n = 10 675 480). We used Poisson regression models to examine these associations for 2011. We then used a fitted nonlinear model to compare changes in outcomes between 2001 and 2011 by type of medical home.
  
  
  RESULTS
  In 2011, patients in a team-based capitation setting were more likely than those in an enhanced fee-for-service setting to receive diabetes monitoring (39.7% v. 31.6%, adjusted relative risk [RR] 1.22, 95% confidence interval [CI] 1.18 to 1.25), mammography (76.6% v. 71.5%, adjusted RR 1.06, 95% CI 1.06 to 1.07) and colorectal cancer screening (63.0% v. 60.9%, adjusted RR 1.03, 95% CI 1.02 to 1.04). Over time, patients in medical homes with team-based capitation experienced the greatest improvement in diabetes monitoring (absolute difference in improvement 10.6% [95% CI 7.9% to 13.2%] compared with enhanced fee for service; 6.4% [95% CI 3.8% to 9.1%] compared with non-team-based capitation) and cervical cancer screening (absolute difference in improvement 7.0% [95% CI 5.5% to 8.5%] compared with enhanced fee for service; 5.3% [95% CI 3.8% to 6.8%] compared with non-team-based capitation). For breast and colorectal cancer screening, there were no significant differences in change over time between different types of medical homes.
  
  
  CONCLUSIONS
  The shift to capitation payment and the addition of team-based care in Ontario were associated with moderate improvements in processes related to diabetes care, but the effects on cancer screening were less clear.
authors.affiliation: Department of Family and Community Medicine (Kiran, Glazier) and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Kiran, Glazier), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Kiran, Kopp, Moineddin, Glazier), Toronto, Ont.; Department of Family and Community Medicine (Moineddin), University of Toronto, Toronto, Ont. tara.kiran@utoronto.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
authors.affiliation: Department of Family and Community Medicine (Kiran, Glazier) and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Kiran, Glazier), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Kiran, Kopp, Moineddin, Glazier), Toronto, Ont.; Department of Family and Community Medicine (Moineddin), University of Toronto, Toronto, Ont.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.affiliation: Department of Family and Community Medicine (Kiran, Glazier) and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Kiran, Glazier), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Kiran, Kopp, Moineddin, Glazier), Toronto, Ont.; Department of Family and Community Medicine (Moineddin), University of Toronto, Toronto, Ont.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Department of Family and Community Medicine (Kiran, Glazier) and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Kiran, Glazier), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Kiran, Kopp, Moineddin, Glazier), Toronto, Ont.; Department of Family and Community Medicine (Moineddin), University of Toronto, Toronto, Ont.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy; D002204:Capitation Fee; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000191:economics / Q000628:therapy; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000628:therapy*; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000191:economics; D011320:Primary Health Care / Q000191:economics*; D012044:Regression Analysis; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000628:therapy; D055815:Young Adult