Robert Geneau
Public Health Agency of Canada
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Annals of Family Medicine | 2009
Grant Russell; Simone Dahrouge; William Hogg; Robert Geneau; Laura Muldoon; Meltem Tuna
PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identified which practice organizational factors were independently associated with high-quality care. METHODS We undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identified those organizational factors independently associated with chronic disease management. RESULTS Chronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONS The study adds to the literature supporting the value of nurse-practitioners within primary care teams and validates the contributions of Ontario’s CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patient-physician ratios may have unanticipated negative effects on processes of care quality.
Canadian Medical Association Journal | 2013
Marie-Dominique Beaulieu; Jeannie Haggerty; Pierre Tousignant; Janet Barnsley; William Hogg; Robert Geneau; Eveline Hudon; Réjean Duplain; Jean-Louis Denis; Lucie Bonin; Claudio Del Grande; Natalyia Dragieva
Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. Results: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0–35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8–14.4), presence of allied health professionals (15.3; 95% CI 5.4–25.2) and/or specialist physicians (19.6; 95% CI 8.3–30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0–12.4) and average organizational access to the practice (4.9; 95% CI 2.6–7.2). The number of physicians (1.2; 95% CI 0.6–1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1–2.5) were modestly associated with high-quality care. Interpretation: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.
Evaluation | 2009
Nassera Touati; Raynald Pineault; Jean-Louis Denis; Astrid Brousselle; André-Pierre Contandriopoulos; Robert Geneau
Based on the example of the evaluation of service organization models, this article shows how a configurational approach overcomes the limits of traditional methods which for the most part have studied the individual components of various models considered independently of one another. These traditional methods have led to results (observed effects) that are difficult to interpret. The configurational approach, in contrast, is based on the hypothesis that effects are associated with a set of internally coherent model features that form various configurations. These configurations, like their effects, are context-dependent. We explore the theoretical basis of the configuration approach in order to emphasize its relevance, and discuss the methodological challenges inherent in the application of this approach through an in-depth analysis of the scientific literature. We also propose methodological solutions to these challenges. We illustrate from an example how a configurational approach has been used to evaluate primary care models. Finally, we begin a discussion on the implications of this new evaluation approach for the scientific and decision-making communities.
Open Medicine | 2009
Simone Dahrouge; William Hogg; Grant Russell; Robert Geneau; Elizabeth Kristjansson; Laura Muldoon; Sharon Johnston
Open Medicine | 2009
William Hogg; Simone Dahrouge; Grant Russell; Meltem Tuna; Robert Geneau; Laura Muldoon; Elizabeth Kristjansson; Sharon Johnston
Canadian Family Physician | 2010
Laura Muldoon; Simone Dahrouge; William Hogg; Robert Geneau; Grant Russell; Michael Shortt
Archive | 2011
Howard Morrison; Robert A. Spasoff; Claire Infante-Rivard; Elizabeth Kristjansson; Michelle Tracy; Lesley Doering; Robert Geneau; Lesli Mitchell; Scott B. Patten; Barry Pless; Kerry Robinson; Fabiola Tatone-Tokuda; Carling Avenue
Archive | 2007
Grant Mervyn Russell; Robert Geneau; S Johnston; Sharon Johnston; Clare Liddy; William Hogg; K Hogan
Canadian Family Physician | 2014
Marie-Dominique Beaulieu; Robert Geneau; Claudio Del Grande; Jean-Louis Denis; Eveline Hudon; Jeannie Haggerty; Lucie Bonin; Réjean Duplain; Johanne Goudreau; William Hogg
North American Primary Care Research Group Annual Meeting 2009 | 2010
Grant Mervyn Russell; John Saultz; Robert Geneau; Barbara Farrell; Natalie Ward; Samantha Evans; Patricia Thille