Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

PURPOSE 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.

METHODS 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.

RESULTS 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.

CONCLUSION 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.