title: Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada.
abstract: Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes.
  
  
  
  We used administrative data for diabetes monitoring and cancer screening to compare services received by patients attached to a medical home (n = 10,785,687) with services received by those seeing a fee-for-service physician (n = 1,321,800) in Ontario, Canada, on March 31, 2011. We used Poisson regression to examine associations in 2011 after adjustment for patient factors and also assessed changes in outcomes between 2001 and 2011.
  
  
  
  Patients attached to a fee-for-service physician were more likely to be immigrants and live in a low-income neighborhood and urban area. They were less likely to receive recommended testing for diabetes (25% vs 34%; adjusted relative risk [RR] = 0.74; 95% CI, 0.73-0.75) and less likely to receive screening for cervical (52% vs 66%; adjusted RR = 0.79; 95% CI, 0.79-0.79), breast (58% vs 73%; adjusted RR = 0.80; 95% CI, 0.80-0.81), and colorectal cancer (44% vs 62%; adjusted RR = 0.72; 95% CI, 0.71-0.72) compared with patients attached to a medical home physician in 2011. These differences in quality of care preceded medical home reforms.
  
  
  
  Patients left behind from medical home reforms are more likely to be poor, urban, and new immigrants and receive lower quality care. Strategies are needed to reach out to these patients and their physicians to reduce gaps in care.
authors.affiliation: Department of Family and Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada tara.kiran@utoronto.ca.|Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.affiliation: Department of Family and Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada.|Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000175:diagnosis; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis; D009735:Nursing Homes; D009864:Ontario / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D000069341:Transitional Care / Q000191:economics / Q000592:standards*; D014505:Urban Population; D055815:Young Adult
keywords: access to health care; health care delivery; health care disparities; health policy; primary health care