Measuring the impacts of primary care for patients with multimorbid chronic disease: Evaluating policy reforms in BC and Quebec

Patients living with two or more chronic diseases represent 12% of the Canadian population but account for half of hospital days and a quarter of physician consultations. Good primary care, including monitoring of chronic conditions and coordination of care with specialists and hospitals, is especially important for these patients. Unfortunately, Canada performs poorly in international comparisons of primary care for patients with serious illness. Provinces have tried different approaches to improve primary care delivery. Some introduced team-based practices that include physicians, nurses, and other health professionals. Others aimed to change the behaviour of individual family doctors through incentive payments. Despite considerable investment, policymakers still lack quality evidence of the potential effects and unintended consequences of both approaches. Existing studies do not sufficiently account for the different characteristics of patients and physicians who choose to participate in new initiatives. There is huge potential to directly compare approaches across provinces to identify the most promising reforms. In practice, multiple barriers exist, and research across provinces rarely occurs. This research will compare the effects of reform in Quebec, which introduced team-based care, and British Columbia, which introduced incentive payments for physicians. Routinely collected data capturing patient characteristics, physician billing, and hospital admissions will be used to develop comparable measures of quality, use, and costs for comparison. In both provinces, physicians and patients that did and did not participate differ. Careful study design that makes comparisons across provinces, as well as before and after the introduction of new policies, combined with statistical techniques for adjustment and modelling of effects, allow us to estimate the true impact of reform in each province.