Did changing primary care delivery models change performance? A population based study using health administrative data

<p>Abstract</p> <p>Background</p> <p>Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.</p> <p>Methods</p> <p>This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal) and chronic disease management (diabetes, heart failure, asthma).</p> <p>Results</p> <p>Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms). In other cases it was improving in relation to previous measures (colorectal cancer screening). There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN.</p> <p>Conclusions</p> <p>Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.</p

Professionalism, Golf Coaching and a Master of Science Degree: A commentary

As a point of reference I congratulate Simon Jenkins on tackling the issue of professionalism in coaching. As he points out coaching is not a profession, but this does not mean that coaching would not benefit from going through a professionalization process. As things stand I find that the stimulus article unpacks some critically important issues of professionalism, broadly within the context of golf coaching. However, I am not sure enough is made of understanding what professional (golf) coaching actually is nor how the development of a professional golf coach can be facilitated by a Master of Science Degree (M.Sc.). I will focus my commentary on these two issues

Coarsening in the q-State Potts Model and the Ising Model with Globally Conserved Magnetization

We study the nonequilibrium dynamics of the $q$-state Potts model following a quench from the high temperature disordered phase to zero temperature. The time dependent two-point correlation functions of the order parameter field satisfy dynamic scaling with a length scale $L(t)\sim t^{1/2}$. In particular, the autocorrelation function decays as $L(t)^{-\lambda(q)}$. We illustrate these properties by solving exactly the kinetic Potts model in $d=1$. We then analyze a Langevin equation of an appropriate field theory to compute these correlation functions for general $q$ and $d$. We establish a correspondence between the two-point correlations of the $q$-state Potts model and those of a kinetic Ising model evolving with a fixed magnetization $(2/q-1)$. The dynamics of this Ising model is solved exactly in the large q limit, and in the limit of a large number of components $n$ for the order parameter. For general $q$ and in any dimension, we introduce a Gaussian closure approximation and calculate within this approximation the scaling functions and the exponent $\lambda (q)$. These are in good agreement with the direct numerical simulations of the Potts model as well as the kinetic Ising model with fixed magnetization. We also discuss the existing and possible experimental realizations of these models.Comment: TeX, Vanilla.sty is needed. [Admin note: author contacted regarding missing figure1 but is unable to supply, see journal version (Nov99)

From one cell to the whole froth: a dynamical map

We investigate two and three-dimensional shell-structured-inflatable froths, which can be constructed by a recursion procedure adding successive layers of cells around a germ cell. We prove that any froth can be reduced into a system of concentric shells. There is only a restricted set of local configurations for which the recursive inflation transformation is not applicable. These configurations are inclusions between successive layers and can be treated as vertices and edges decorations of a shell-structure-inflatable skeleton. The recursion procedure is described by a logistic map, which provides a natural classification into Euclidean, hyperbolic and elliptic froths. Froths tiling manifolds with different curvature can be classified simply by distinguishing between those with a bounded or unbounded number of elements per shell, without any a-priori knowledge on their curvature. A new result, associated with maximal orientational entropy, is obtained on topological properties of natural cellular systems. The topological characteristics of all experimentally known tetrahedrally close-packed structures are retrieved.Comment: 20 Pages Tex, 11 Postscript figures, 1 Postscript tabl

A surprising method for polarising antiprotons

We propose a method for polarising antiprotons in a storage ring by means of a polarised positron beam moving parallel to the antiprotons. If the relative velocity is adjusted to $v/c \approx 0.002$ the cross section for spin-flip is as large as about $2 \cdot 10^{13}$ barn as shown by new QED-calculations of the triple spin-cross sections. Two possibilities for providing a positron source with sufficient flux density are presented. A polarised positron beam with a polarisation of 0.70 and a flux density of approximately $1.5 \cdot 10^{10}$/(mm$^2$ s) appears to be feasible by means of a radioactive $^{11}$C dc-source. A more involved proposal is the production of polarised positrons by pair production with circularly polarised photons. It yields a polarisation of 0.76 and requires the injection into a small storage ring. Such polariser sources can be used at low (100 MeV) as well as at high (1 GeV) energy storage rings providing a time of about one hour for polarisation build-up of about $10^{10}$ antiprotons to a polarisation of about 0.18. A comparison with other proposals show a gain in the figure-of-merit by a factor of about ten.Comment: 13 pages, 8 figures; v2: minor language and signification corrections v3: (14 pages, 12 figures) major error, nonapplicable polarisation transfer cross sections replaced by the mandatory spin-flip cross section

Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study

BACKGROUND: Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS: We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS: We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION: Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination

Background: The literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by race/ethnicity and world region of origin and destination. Methods: A systematic review and meta-regression analyses were conducted using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies. Results: Twenty-four studies, involving more than 30 million singleton births, met the inclusion criteria. Compared with US-born black women, black migrant women were at lower odds of delivering LBW and preterm birth babies. Hispanic migrants also exhibited lower odds for these outcomes, but Asian and white migrants did not. Sub-Saharan African and Latin-American and Caribbean women were at higher odds of delivering LBW babies in Europe but not in the USA and south-central Asians were at higher odds in both continents, compared with the native-born populations. Conclusions: The association between migration and adverse birth outcomes varies by migrant subgroup and it is sensitive to the definition of the migrant and reference groups

Evryscope-south survey of upper-and pre-main sequence solar neighborhood stars

Using photometric data collected by Evryscope-South, we search for nearby young variable systems on the upper main sequence (UMS) and pre-main sequence (PMS). The Evryscopes are all-sky high-cadence telescope arrays operating in the Northern and Southern hemispheres. We base our search on a Gaia-selected catalog of young neighborhood upper-and pre-main sequence stars which were chosen through both astrometric and photometric criteria. We analyze 44,971 Evryscope-South light curves in search of variability. We recover 615 variables, with 378 previously known, and 237 new discoveries including 84 young eclipsing binaries (EB) candidates. We discover a new highly eccentric binary system and recover a further four previously known systems, with periods ranging from 299 to 674 hr. We find 158 long-period (>50 hr) candidate EB systems, 9 from the PMS and 149 from the UMS, which will allow constraints on the mass/radius/age relation. These long-period EBs include a 179.3 hr PMS system and a 867.8 hr system from the UMS. For PMS variable candidates we estimate system ages, which range from 1 to 23 Myr for non-EBs and from 2 to 17 Myr for EBs. Other non-EB discoveries that show intrinsic variability will allow relationships between stellar rotation rates, ages, activity, and mass to be characterized

Study on Multicellular Systems Using a Phase Field Model

A model of multicellular systems with several types of cells is developed from the phase field model. The model is presented as a set of partial differential equations of the field variables, each of which expresses the shape of one cell. The dynamics of each cell is based on the criteria for minimizing the surface area and retaining a certain volume. The effects of cell adhesion and excluded volume are also taken into account. The proposed model can be used to find the position of the membrane and/or the cortex of each cell without the need to adopt extra variables. This model is suitable for numerical simulations of a system having a large number of cells. The two-dimensional results of cell adhesion, rearrangement of a cell cluster, and chemotaxis as well as the three-dimensional results of cell clusters on the substrate are presented.Comment: 13 pages, 7 figure

First measurements of the ^16O(e,e'pn)^14N reaction

This paper reports on the first measurement of the ^16O(e,e'pn)^14N reaction. Data were measured in kinematics centred on a super-parallel geometry at energy and momentum transfers of 215 MeV and 316 MeV/c. The experimental resolution was sufficient to distinguish groups of states in the residual nucleus but not good enough to separate individual states. The data show a strong dependence on missing momentum and this dependence appears to be different for two groups of states in the residual nucleus. Theoretical calculations of the reaction using the Pavia code do not reproduce the shape or the magnitude of the data.Comment: 10 pages, 11 figures, 2 tables, Accepted for publication in EPJ