The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada
Bibliographic record
Abstract
• Patient enrolment with a source of primary care should support continuity of care. • The impact of enrolment policies on affiliation is an important intermediate outcome. • Our Reporting a Regular Medical Doctor index adds the patient view on affiliation. • Quebec enrolment policies did not improve three measures of affiliation. • Enrolment alone is insufficient to increase affiliation, a key input to continuity. Affiliation, defined as having a usual source of care, revealed by patterns of repeated interactions between the patient and a clinician over time, can influence patients’ care experience, continuity of care and health outcomes. Many jurisdictions implement primary care enrolment policies, with the motivation to increase affiliation and thereby improve downstream patient outcomes. However, there is little evidence on the impacts of these policies on patient-physician affiliation. Using health administrative data, we evaluated the population-level effects of two policies that encourage primary care enrolment on affiliation in Quebec, Canada. We used quasi-experimental study designs (difference-in-difference and interrupted-time-series) to estimate changes in affiliation that could be attributed to the introduction of these policies. The 2003 policy targeted the enrolment of elderly and/or chronically ill patients, whereas the 2009 policy targeted the general population. We used three measures of patient-physician affiliation: dichotomous and continuous usual provider continuity, and the Reporting a Regular Medical Doctor (RRMD) index. Our analyses for both policies did not yield substantively important changes in our outcomes at the population level. Our effect estimates for both policies were stable under several robustness checks specific to each method. Our results suggest that policies that encourage enrolment do not, on their own, have an impact on patient-physician affiliation. If enrolment policies are not sufficient to increase patient-physician affiliation, further research is needed to understand the factors that influence both affiliation and other downstream 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 | 0.024 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 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".