Does quality of primary care vary across delivery models?
Bibliographic record
Abstract
ABSTRACTObjectives To determine the relationships between five models of primary care service delivery and quality of care indicators in an urban population. Two fee-for-service (FFS) and three alternative-funded models of primary care service delivery were studiedApproach We allocated all Manitoba residents who had at least three visits to any primary care provider (PCP) at any Winnipeg clinic between 2010-2013 to the most responsible PCP (N = 626,264). We then allocated each PCP to a model of primary care service delivery. We created general linear mixed models to describe the relationship between each model of primary care and the dominant, traditional fee-for-service model for health services use, while controlling for a variety of PCP and patient factors, including patient social complexity.Results Patient social complexity was associated with poorer crude rates for many of the indicators. There were no differences among the models for hospital readmission within 30 days or specialist referral by the assigned PCP. Hospitalizations for ACSC were higher for one alternative funded model (1.98 OR, 1.38-2.83 95% CI), while non-indicated low back X-rays were lower for a different alternative funded model (0.14 OR, 0.03-0.59 95% CI). Ambulatory care visits to any PCP were lower for all three alternative funded models than the two FFS models. The family medicine academic teaching sites had lower rates of continuity of care (p< 0.5)Conclusion Overall, no model of primary care consistently outperformed the others. FFS models had higher rates of visits, but appeared to satisfy patient needs better because they had less use of telehealth services following visits. Teaching sites appeared to sacrifice continuity of care potentially to support other academic activities. Controlling for social complexity was associated with a reduction in the differences between models in indicator outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.073 | 0.212 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.005 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.004 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".