Comparing the Attainment of the Patient’s Medical Home Model across Regions in Three Canadian Provinces: A Cross-Sectional Study
Bibliographic record
Abstract
Background: The aim of this work was to show the feasibility of providing a comprehensive portrait of regional primary care performance.Methods: The TRANSFORMATION study used a mixed-methods concurrent study design where we analyzed survey data and case studies.Data were collected in British Columbia, Ontario and Nova Scotia.Patient' s Medical Home (PMH) pillar scores were created by calculating mean clinic-level scores across regions.Scores and qualitative themes were compared.Results: Participation included 86 practices (n = 1,929 patients; n = 117 clinicians).Regions had differential attainment towards PMH orientation with respect to infrastructure; community adaptiveness and accountability; and patient and family partnered care.The lowest PMH attainment for all regions were observed in connected care; accessible care; measurement, continuous quality improvement and research; and training, education and continuing professional development.Conclusions: Comprehensive performance reporting that draws on multiple data sources in primary care is possible.Regional portraits highlighting many of the key pillars of a PMH approach to primary care show that despite differences in policy contexts, achieving a PMH remains elusive. RésuméContexte : L' objectif de ce travail est de montrer la faisabilité de brosser un portrait complet de la performance régionale des soins primaires.Méthode : L'étude de TRANSFORMATION a eu recours à des méthodes mixtes simultanées pour analyser les données d' enquête et les études de cas.Les données ont été recueillies en Colombie-Britannique, en Ontario et en Nouvelle-Écosse.Les scores du pilier des centres de médecine de famille (CMF) ont été obtenus en calculant les scores moyens cliniques dans toutes les régions.Les scores et les thèmes qualitatifs ont été comparés.Résultats : L'étude a porté sur 86 cliniques (n = 1 929 patients, n = 117 cliniciens).Les régions ont obtenu des résultats différents en matière d' orientation des CMF en ce qui concerne l'infrastructure, l' adaptabilité et la responsabilité communautaires, ainsi que les soins en partenariat avec le patient et la famille.Les résultats les plus bas des CMF pour toutes les régions ont été observés dans les soins connectés, les soins accessibles, les mesures, l' amélioration continue de la qualité et la recherche, ainsi que la formation, l'éducation et la formation professionnelle continue.Conclusions : Il est possible de produire un rapport de performance complet qui s' appuie sur plusieurs sources de données en soins primaires.Les portraits régionaux qui mettent en évidence bon nombre des piliers clés d' une approche des CMF en soins primaires montrent que, malgré les différences dans les contextes politiques, la réalisation d' un CMF reste insaisissable.
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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 | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".