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Project Description

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The Physician Integrated Network (PIN) is a Primary Care Reform Initiative in Manitoba intended to improve access to high quality primary care through networked primary care physicians in collaboration with other providers. Now in Phase 2, this initiative includes 167 physicians working in 13 primary care clinics, who applied to participate in the initiative. Patients who attend these clinics for care are not required to sign up. PIN is a provider focused intervention with a pay-for-performance (P4P) component in addition to information technology support.
 
The P4P indicators focus on prevention (including childhood immunizations and breastfeeding) and chronic disease management (including asthma). Recent work at MCHP confirmed inequities in childhood immunization, with rates varying from 83.8% in the lowest to 92.4% in the highest income quintiles in 2007/08 (1). Immunization rates have been stable in Manitoba over the past 8 years, but P4P has resulted in improved uptake of the clinical interventions being rewarded (2,3). No studies to date have explored whether the actual socioeconomic gap itself is reduced through P4P – overall rates can potentially increase, but there could be the unfortunate outcome of increasing rates only in higher income groups. Inequities have also been documented for breastfeeding rates in Manitoba (4,5), and for treatment of asthma in rural Manitoba (5). This study proposes to look at the PIN intervention and its effect on reducing inequities in childhood immunization, breastfeeding initiation and asthma treatment.

Research Question

Are the immunization rates higher for children attending PIN clinics than those attending other clinics and is the inequity lower amongst those attending PIN clinics?

Additional outcome variables to be explored include breastfeeding initiation and quality of asthma care.
 

Hypotheses

1. The rates of childhood immunization at PIN clinics will be higher than those attending non PIN clinics for their primary care.

2. The quality of asthma care will be higher for patients attending PIN clinics.

3. Breastfeeding initiation rates will be higher at PIN clinics.

4. The socioeconomic gaps in each of the indicators above will decrease at PIN clinics, but will not change at non PIN clinics.


References

(1) Hilderman T, Katz A, Derksen S et al. The Manitoba Immunization Study. Winnipeg, MB: Manitoba Centre for Health Policy; 2011.
 
(2) Hazelwood A, Cook ED. Improving quality of health care through pay-for-performance programs. Health Care Manag (Frederick) 2008 April;27(2):104-12.
 
(3) Glickman SW, Ou FS, DeLong ER et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA 2007 June 6;297(21):2373-80.
 
(4) Martens PJ, Brownell M, Au W et al. Health inequities in Manitoba: Is the socioeconomic gap widening or narrowing over time? Winnipeg, MB: Manitoba Centre for Health Policy; 2010.
 
(5) Brownell M, De Coster C, Penfold R et al. Manitoba child health atlas update. Winnipeg, MB: Manitoba Centre for Health Policy; 2008.