• François Lehmann, David Dunn, Marie-Dominique Beaulieu, and James Brophy.
• Associate Clinical Professor in the Department of Family and Emergency Medicine at the University of Montreal in Quebec. francois.lehmann@umontreal.ca.
• Can Fam Physician. 2016 Aug 1; 62 (8): e448e456e448-56.

ObjectiveTo evaluate the changes in accessibility, patients' care experiences, and quality-of-care indicators following a clinic's transformation into a fully integrated network clinic.DesignMixed-methods study.SettingVerdun, Que.ParticipantsData on all patient visits were used, in addition to 2 distinct patient cohorts: 134 patients with chronic illness (ie, diabetes, arteriosclerotic heart disease, or both); and 450 women between the ages of 20 and 70 years.Main Outcome MeasuresAccessibility was measured by the number of walk-in visits, scheduled visits, and new patient enrolments. With the first cohort, patients' care experiences were measured using validated serial questionnaires; and quality-of-care indicators were measured using biologic data. With the second cohort, quality of preventive care was measured using the number of Papanicolaou tests performed as a surrogate marker.ResultsDespite a negligible increase in the number of physicians, there was an increase in accessibility after the clinic's transition to an integrated network model. During the first 4 years of operation, the number of scheduled visits more than doubled, nonscheduled visits (walk-in visits) increased by 29%, and enrolment of vulnerable patients (those with chronic illnesses) at the clinic remained high. Patient satisfaction with doctors was rated very highly at all points of time that were evaluated. While the number of Pap tests done did not increase with time, the proportion of patients meeting hemoglobin A1c and low-density lipoprotein guideline target levels increased, as did the number of patients tested for microalbuminuria.ConclusionTransformation to an integrated network model of care led to increased efficiency and enhanced accessibility with no negative effects on the doctor-patient relationship. Improvements in biologic data also suggested better quality of care.Copyright© the College of Family Physicians of Canada.

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