title: Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec's Family Medicine Groups, 2002-2010.
abstract: BACKGROUND
  We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance.
  
  
  METHODS
  We conducted a natural experiment including 135,119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000-2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models.
  
  
  RESULTS
  Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI]=-2.83% [-4.08%, -1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI]=-0.24% [-2.24%; 1.75%]).
  
  
  CONCLUSIONS
  We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators.
authors.affiliation: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Ave. West, Montreal, QC H3A 1A2 Canada; Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Diop
authors.affiliation: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Ave. West, Montreal, QC H3A 1A2 Canada; Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Fiset-Laniel
authors.affiliation: Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada; Institut de recherche en santé publique de l'Université de Montréal, Pavillon 7101 avenue du Parc, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7 Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Provost
authors.affiliation: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Ave. West, Montreal, QC H3A 1A2 Canada; Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tousignant
authors.affiliation: Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada; Université de Montréal, Faculté des sciences infirmières, Marguerite-d'Youville C.P 6128, succursale Centre-ville, Montréal, QC H3C 3J7 Canada.
authors.forename: Roxane
authors.initials: R
authors.lastname: Borgès Da Silva
authors.affiliation: Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada.
authors.forename: Marie-Jo
authors.initials: MJ
authors.lastname: Ouimet
authors.affiliation: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Ave. West, Montreal, QC H3A 1A2 Canada; Douglas Mental Health University Institute, Perry Pavilion Room E-3114, 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Latimer
authors.affiliation: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Ave. West, Montreal, QC H3A 1A2 Canada; Direction de santé publique du CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301 Sherbrooke St. East, Montreal, QC H2L 1M3 Canada; Institut de recherche en santé publique de l'Université de Montréal, Pavillon 7101 avenue du Parc, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7 Canada; McGill University, Department of Economics, 855 Sherbrooke St. West, Leacock 418, Montreal, QC H3A 2T7 Canada. Electronic address: erin.strumpf@mcgill.ca.
authors.forename: Erin
authors.initials: E
authors.lastname: Strumpf
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D005194:Family Practice / Q000458:organization & administration*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D011792:Quebec
keywords: Chronic disease; Clinical guideline adherence; Difference-in-differences; Quality of care; Team-based primary care