• Tara Kiran, Alexander Kopp, Rahim Moineddin, and Richard H Glazier.
• Department of Family and Community Medicine (Kiran, Glazier) and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Kiran, Glazier), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Kiran, Kopp, Moineddin, Glazier), Toronto, Ont.; Department of Family and Community Medicine (Moineddin), University of Toronto, Toronto, Ont. tara.kiran@utoronto.ca.
• CMAJ. 2015 Nov 17; 187 (17): E494E502E494-E502.

BackgroundWe evaluated a large-scale transition of primary care physicians to blended capitation models and team-based care in Ontario, Canada, to understand the effect of each type of reform on the management and prevention of chronic disease.MethodsWe used population-based administrative data to assess monitoring of diabetes mellitus and screening for cervical, breast and colorectal cancer among patients belonging to team-based capitation, non-team-based capitation or enhanced fee-for-service medical homes as of Mar. 31, 2011 (n = 10 675 480). We used Poisson regression models to examine these associations for 2011. We then used a fitted nonlinear model to compare changes in outcomes between 2001 and 2011 by type of medical home.ResultsIn 2011, patients in a team-based capitation setting were more likely than those in an enhanced fee-for-service setting to receive diabetes monitoring (39.7% v. 31.6%, adjusted relative risk [RR] 1.22, 95% confidence interval [CI] 1.18 to 1.25), mammography (76.6% v. 71.5%, adjusted RR 1.06, 95% CI 1.06 to 1.07) and colorectal cancer screening (63.0% v. 60.9%, adjusted RR 1.03, 95% CI 1.02 to 1.04). Over time, patients in medical homes with team-based capitation experienced the greatest improvement in diabetes monitoring (absolute difference in improvement 10.6% [95% CI 7.9% to 13.2%] compared with enhanced fee for service; 6.4% [95% CI 3.8% to 9.1%] compared with non-team-based capitation) and cervical cancer screening (absolute difference in improvement 7.0% [95% CI 5.5% to 8.5%] compared with enhanced fee for service; 5.3% [95% CI 3.8% to 6.8%] compared with non-team-based capitation). For breast and colorectal cancer screening, there were no significant differences in change over time between different types of medical homes.InterpretationThe shift to capitation payment and the addition of team-based care in Ontario were associated with moderate improvements in processes related to diabetes care, but the effects on cancer screening were less clear.© 2015 Canadian Medical Association or its licensors.

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