Patients of Comprehensive Primary Care Physicians Receive Better Care and Have Better Outcomes: Findings from Ontario, Canada
Notice bibliographique
Résumé
Context: Comprehensiveness is a key attribute of primary care. In recent years many metrics have been developed to identify comprehensive primary care practice, but with limited understanding of their relationship with health care and outcomes. In this study we use a published measure of primary care comprehensiveness to group physicians and then examine the patterns of care, health service use and health outcomes among their patients. Objective: To compare the patterns of care, health service use and health outcomes of patients of physicians who are comprehensive, in various types of focused practice, and other practice types. Study Design and Analysis: Population-based cross-sectional study. Setting or Dataset: The province of Ontario, Canada. Data sources included population-based primary are physician claims, provider databases, patient registration with a primary care physician and provincial health care utilization databases. Population studied: All primary care physicians in active practice in Ontario in 2019/20 and all individuals in Ontario who could be assigned to a primary care physician. Outcome Measures: Physicians were grouped by practice type and then their patients were identified using the provincial primary care registration database and primary care physician claims. Patient characteristics such as demographics and prevalence of chronic conditions were estimated. Patient outcomes included diabetes care, cancer screening rates and utilization of health care services for ambulatory care sensitive conditions. Results: Of 15,745 physicians, 15% had no assigned patients and were excluded. Of those included, 73% were comprehensive, 13% in focused practice, 9% very part-time and 5% other. Comprehensive physicians had the largest patient panels (mean 1,258 versus 249 for focused practice), higher rates of cancer screening (63.1% versus 46.5%) and diabetes care (69.0% with retinal exams versus 60.8%) and lower rates of hospitalizations for ambulatory care sensitive conditions (2.7 versus 15.0 per 1000) and emergency department (ED) visits (415.3 versus 856.2 per 1000). Conclusions: Primary care physician comprehensiveness is associated with improved preventive health care and chronic disease management and lower ED and hospital utilization. Policies and strategies to enhance comprehensive practice, attach patients to comprehensive physicians, and improve care for those being managed largely in non-comprehensive practices are needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,007 |
| Études des sciences et des technologies | 0,005 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».