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Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

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      Abstract

      Background

      The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care.

      Objectives

      In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance.

      Methods/Design

      This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC.

      Discussion

      The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.

      Related collections

      Most cited references 30

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      Contribution of primary care to health systems and health.

      Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.
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        Improving primary care for patients with chronic illness.

        The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components-self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources-can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case studies are provided describing how components of the chronic care model have been implemented in the primary care practices of 4 health care organizations.
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          MODES OF THEORIZING IN STRATEGIC HUMAN RESOURCE MANAGEMENT: TESTS OF UNIVERSALISTIC, CONTINGENCY, AND CONFIGURATIONS. PERFORMANCE PREDICTIONS.

           D Doty,  J. DELERY (1996)
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            Author and article information

            Affiliations
            [1 ]Institut national de santé publique du Québec, Québec, Canada
            [2 ]Centre de recherche du Centre hospitalier de l'Université de Montréal, Québec, Canada
            [3 ]Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Québec, Canada
            Contributors
            Journal
            BMC Fam Pract
            BMC Family Practice
            BioMed Central
            1471-2296
            2010
            1 December 2010
            : 11
            : 95
            3014883
            1471-2296-11-95
            21122145
            10.1186/1471-2296-11-95
            Copyright ©2010 Levesque et al; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Study Protocol

            Medicine

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