INSPIRE PHC - Primary Health CAre Program:INnovations Strengthening PrImary Healthcare REsearch
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Research Leads

Dr. Rick Glazier Dr. Rick Glazier
Senior Scientist & Lead, Primary Care and Population Health Program, Institute for Clinical Evaluative Sciences (ICES), Professor, Department of Family & Community Medicine, University of Toronto
Dr. Simone Dahrouge Dr. Simone Dahrouge
Director of Research, and Scientist, at the C.T. Lamont Primary Health Care Research Centre within the Bruyere Research Institute, Assistant Professor, University of Ottawa
Dr. Michael Green Dr. Michael Green
Associate Professor in the Departments of Family Medicine and Community Health and Epidemiology, Queen's University
Gina Agarwal, Imaan Bayoumi, Judith Belle Brown, Karen Hall-Barber, Stewart Harris, Roberta Heale, William Hogg, Michelle Howard,Jongnam Hwang, Liissa Jaakkimanien, Sharon Johnston, Claire Kendall, Tara Kiran, Aisha Lofters, Doug Manuel, Liz Muggah, Laura Muldoon, Andrew Pinto, Kevin Pottie, Graham Reid, Bridget L. Ryann, Monica Taljaard, Amardeep Thind, Joan Tranmer
Eliot Frymire
Project Manager
Research Project Links

PC Reform
Optimizing quality, access, integration and equity in Ontario primary care

Care in the Home (TAPESTRY)
Primary health care linking with community (TAPESTRY-CM)

Community Linkage - SCOPE
Enhancing PHC linkages with home care and hospitals (SCOPE)

Specialist Linkage -eConsult
Creating new PHC linkages with specialists

Knowledge Translation Exchange (KTE)

Sex and Gender Analysis

Research Projects...


PC Reform: Optimizing quality, access, integration and equity in Ontario primary care

Much of what we know about models of primary care reform in Ontario dates from the early 2000's when the Primary Health Care Transition Funds were used in Ontario to provide knowledge about models current at that time. Current research suggests that PC models have somewhat different socio-demographic profiles but their geographic distribution and reach in relation to population needs has not been previously examined. Therefore, our studies will address the current issues in primary care reform: attributes of reform; quality of chronic disease care; economic impact; access, integration and equity and disparities.

The studies outlined below will make use of secondary data sources housed at the Institute for Clinical Evaluative Sciences (ICES). The project team are all ICES appointed scientists and have access to the data sets at their institutions through local access sites. Data sets that will be utilized will include well established data sets such as OHIP Billing Data, ODB prescribing information, provider information, hospital and ER utilization (DAD and NACRS), census data and the CCHS, as well as newly available and soon to be available data such as Family Health Team specific reporting data, homecare data, the Patient Care Survey and the QUALICOPC survey.

Objective 1: Primary Care Reform and Quality of Care
This project is focussed on the provision of primary preventive and health promotion services which reduce the risk of developing chronic conditions as well as the management of chronic conditions once they have developed. We will capture three broad categories of outcomes:

  1. The Quality of Health Services delivered (coordination, and continuity)
  2. The Technical Quality of Care using these three- temporally linked measures of CDPM:
    • activities related to primary prevention and health promotion and which are important for all patients (e.g. referrals to smoking cessation programs)
    • appropriateness of the care delivered (e.g. anti-hypertensive therapy to control hypertension;
    • long term outcomes (e.g. diabetic renal failure or stroke) for which the risks are multifactorial
  3. Resource Use and Costing

Each of the four groups of measures will contain indicators of several chronic conditions, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, and depression from which a composite score will be derived.

Objective 2:  Access to Care
For this objective, we will use time series analysis to evaluate how PC access has changed between 2003-2013 as reform and quality improvement initiatives were implemented, using the Primary Care Access Survey (PCAS) data (housed at ICES), the upcoming Primary Care Survey (PCS) and data from the QUALICOPC Study to understand Ontarians' experience of access over time. Billing data will be used to assess changes in the pattern of PC use (e.g. after-hours clinics, usual provider continuity) and use of other resources (ER visits, Ambulatory Care Sensitive Admissions, Specialist Visits). Using available data we will explore which PC structures are associated with enhanced access. Potential explanatory factors include PCmodel, participation in Quality Improvement initiatives, use of advanced access scheduling and human resources factors (e.g. number of patients per family physician, ratio of nurse practitioner or other health professional to physician in the practice, or in a geographical region – as described in project 2).

View a poster presented by Dr. Mike Green at CAHSPR (May, 2014) on Access to Care:
'Primary Care Reform in Ontario from 2002-2010: Impact on the Supply and Distribution of Family Physicians'

Objective 3:  Integration
We will examine primary care structures over time in relation to changes in referrals to homecare, timely receipt of homecare after referral, non-urgent ED visits, ambulatory care sensitive hospital admissions, hospital readmissions within 30 days and follow up in primary care within 7 days after hospital discharge. The structural elements of most interest for integration include the type of governance model, the presence and composition of the inter-professional teams, use of telephone consultation codes, use of specialist sessional fees, and participation in Health Links.

Objective 4:  Keeping Ontarians Healthy Through Alignment of Care with Population
Needs Research Questions

What attributes of primary care use and availability are related to health status outcomes across the spectrum of socio-demographic characteristics of Ontarians? Is Ontario's PC aligned with population need? What have been the unintended consequences of the reform strategies for equity? We will consider whether PC is equitable, and responsive and aligned to needs for practice patients and for local communities.