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dc.contributor.authorDixon, Jeffreyen
dc.date2015-12-18 14:47:59.218
dc.date2015-12-23 11:49:48.744
dc.date.accessioned2016-01-05T22:14:38Z
dc.date.available2016-01-05T22:14:38Z
dc.date.issued2016-01-05
dc.identifier.urihttp://hdl.handle.net/1974/13915
dc.descriptionThesis (Master, Community Health & Epidemiology) -- Queen's University, 2015-12-23 11:49:48.744en
dc.description.abstractBackground: This study assessed the relationship between the patient-centred medical home (PCMH), as exemplified by the Family Health Team (FHT) program in Ontario, and healthcare access and utilization by adults with intellectual and developmental disabilities (IDD) aged 18-64 years. Methods: Using administrative data from the Institute for Clinical Evaluative Sciences, a retrospective cohort was developed to compare an intervention group, patients treated through a PCMH model, the FHT, against a control of patients treated through primary care models lacking key features of PCMH care. A difference-in-differences (DiD) approach was used to estimate the effect of the PCMH model on four access indicators – uptake of the periodic health exam, and screens for breast, cervical, and colorectal cancers – and one utilization indicator – avoidable emergency department (ED) utilization rate. Results: FHT-based care reduced the proportion of patients who had an exam over three years by 4.4 percentage points (p<0.0001). It the proportion of patients who were up-to-date with colorectal cancer screens by 4.9 percentage points (p=0.0035). Breast and cervical cancer screenings also showed positive results of 2.9 and 2.4 percentage points respectively, although the results in both were not significant (p=0.214 and 0.0565, respectively). The PCMH care showed no impact on avoidable ED visits. Models were tested for potential confounders including patient demographics, comorbidities, physician demographics, and practice characteristics. In all five tests, the DiD estimator remained relatively constant between simple models and full models which adjusted for confounding variables, suggesting that the models are robust. Conclusions: The results show the complexity of evaluating the impacts of primary care models. The positive trends in cancer screening uptake under PCMH care suggests that with proper incentives PCMH does have a positive impact on access to care by adults with IDD. The negative impact on periodic health exam uptake highlights the need for a tool specific to this population’s needs to ensure guidelines are met. Future research should assess PCMH care against a broader range of healthcare utilization indicators and advance this study’s identification of relevant covariates including complex comorbidities and the effects of physician and practice characteristics on healthcare access and utilization.en
dc.language.isoengen
dc.relation.ispartofseriesCanadian thesesen
dc.rightsQueen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canadaen
dc.rightsProQuest PhD and Master's Theses International Dissemination Agreementen
dc.rightsIntellectual Property Guidelines at Queen's Universityen
dc.rightsCopying and Preserving Your Thesisen
dc.rightsCreative Commons - Attribution - CC BYen
dc.rightsThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.en
dc.rightsThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.en
dc.subjectPrimary Careen
dc.subjectPatient-Centred Medical Homeen
dc.subjectIntellectual and Developmental Disabilitiesen
dc.subjectAccess to Careen
dc.subjectHealth Services and Policy Researchen
dc.subjectDifference-in-Differencesen
dc.titleImpacts of the Patient-Centred Medical Home on Healthcare Access and Utilization Indicators For Adults With Intellectual and Developmental Disabilities in Ontarioen
dc.typethesisen
dc.description.degreeM.Sc.en
dc.contributor.supervisorGreen, Michaelen
dc.contributor.supervisorOuellette-Kuntz, Hélèneen
dc.contributor.departmentCommunity Health and Epidemiologyen
dc.degree.grantorQueen's University at Kingstonen


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