title: Performance of an integrated network model: Evaluation of the first 4 years.
abstract: OBJECTIVE
  To evaluate the changes in accessibility, patients' care experiences, and quality-of-care indicators following a clinic's transformation into a fully integrated network clinic.
  
  
  METHODS
  Mixed-methods study.
  
  
  METHODS
  Verdun, Que.
  
  
  METHODS
  Data on all patient visits were used, in addition to 2 distinct patient cohorts: 134 patients with chronic illness (ie, diabetes, arteriosclerotic heart disease, or both); and 450 women between the ages of 20 and 70 years.
  
  
  METHODS
  Accessibility was measured by the number of walk-in visits, scheduled visits, and new patient enrolments. With the first cohort, patients' care experiences were measured using validated serial questionnaires; and quality-of-care indicators were measured using biologic data. With the second cohort, quality of preventive care was measured using the number of Papanicolaou tests performed as a surrogate marker.
  
  
  RESULTS
  Despite a negligible increase in the number of physicians, there was an increase in accessibility after the clinic's transition to an integrated network model. During the first 4 years of operation, the number of scheduled visits more than doubled, nonscheduled visits (walk-in visits) increased by 29%, and enrolment of vulnerable patients (those with chronic illnesses) at the clinic remained high. Patient satisfaction with doctors was rated very highly at all points of time that were evaluated. While the number of Pap tests done did not increase with time, the proportion of patients meeting hemoglobin A1c and low-density lipoprotein guideline target levels increased, as did the number of patients tested for microalbuminuria.
  
  
  CONCLUSIONS
  Transformation to an integrated network model of care led to increased efficiency and enhanced accessibility with no negative effects on the doctor-patient relationship. Improvements in biologic data also suggested better quality of care.
authors: Associate Clinical Professor in the Department of Family and Emergency Medicine at the University of Montreal in Quebec. francois.lehmann@umontreal.ca.
authors: François
authors: F
authors: Lehmann
authors: The late Dr Dunn was Assistant Professor in the Department of Family and Emergency Medicine at the University of Montreal in the early stages of this study.
authors: David
authors: D
authors: Dunn
authors: Full Professor in the Department of Family and Emergency Medicine at the University of Montreal.
authors: Marie-Dominique
authors: MD
authors: Beaulieu
authors: Full Professor in the Department of Medicine and the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal.
authors: James
authors: J
authors: Brophy
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017146:Models, Organizational; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000592:standards*; D011792:Quebec; D055815:Young Adult