title: Assessing the Effectiveness of Policies to Reduce Diabetes Hospitalizations Before and After the Reforms of Physician Payment and Primary Care Organization in British Columbia and Alberta.
abstract: OBJECTIVE
  Diabetes is one of the most common chronic conditions in Canada. Appropriate care management, particularly in primary care settings, has been demonstrated to improve the outcomes of people with this condition. Policies have been implemented to support primary care providers in providing appropriate diabetes management. This study aimed to evaluate whether policy changes related to improving care have impacted diabetes hospitalizations in British Columbia and Alberta, Canada.
  
  
  METHODS
  This study used a before-and-after evaluation design based on longitudinal administrative data including physicians' claims and hospitalizations from 1998-1999 to 2009-2010. We performed ordinary least squares regressions to assess the variations in diabetes hospitalization rates following the implementation of policies in primary care settings in each province.
  
  
  RESULTS
  Diabetes-related hospitalization rates have been decreasing since 1998 and continued to decrease after the reforms in both provinces. In 1998, the adjusted hospitalization rate for diabetes was 2.9% in Alberta and 1.7% in British Columbia compared to, respectively, 1.1% and 0.8% in 2009. Regression results suggest that the changes in policy in 2003 have had limited impact on outcomes for those with diabetes.
  
  
  CONCLUSIONS
  The hospitalization rates were already declining in both provinces over time, before and after the reform, so it is challenging to disentangle the decrease that could be attributable to policy changes. More research is needed to better understand the impact of changes in primary care on outcomes such as hospitalizations for diabetes.
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA. Electronic address: Maude.laberge@phhp.ufl.edu.
authors.forename: Maude
authors.initials: M
authors.lastname: Laberge
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dala Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Kone Pefoyo
mesh_terms: D000416:Alberta; D001955:British Columbia; D048909:Diabetes Complications / Q000517:prevention & control*; D006291:Health Policy; D006760:Hospitalization; D006801:Humans; D016018:Least-Squares Analysis; D008137:Longitudinal Studies; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation
keywords: diabetes care; difference-in-difference; différence dans la différence; mesures incitatives offertes aux médecins; organisation des soins primaires; physician incentives; primary care organization; soins aux diabétiques