Final Report: An External Evaluation of the Family Health Team (FHT) Initiative

The Conference Board of Canada, December 17, 2014
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Based on the results of a five-year evaluation initiative, this report explores the successes and challenges of the Family Health Team (FHT) model of primary care in Ontario.

Document Highlights

In 2005, Ontario began to implement the Family Health Team (FHT) model to address cost and quality issues plaguing the health care system and to advance the role of primary care. A defining element of FHTs is their ability to offer enhanced patient access to interprofessional, team-based care.

Based on the results of a five-year evaluation initiative, this final report explores the successes and challenges of the FHT initiative across a series of domains including access, prevention and health promotion, internal and specialist care coordination, patient and family centredness, and support for chronic disease management. The evaluation demonstrated that, despite their young age, FHTs have achieved improvements at the organizational and service-delivery levels. While changes in terms of patient experience and outcomes were not yet evident in all domains, there were some early signs of improvement, particularly in chronic disease management.

Table of Contents

Executive Summary

Chapter 1—Introduction

  • Background and Context
  • Scope and Objectives of the FHT Evaluation
  • Organization of Final Report

Chapter 2—Methods

  • Final Report Research Questions
  • Conceptual Framework
  • Study Design
  • Methodology
  • Analytical Approach for Final Report Research Questions

Chapter 3—Representativeness and Study Respondent Characteristics

  • Key Characteristics of FHTs and Their Comparators

Chapter 4—Findings

  • What are the Components and Attributes of the Six Evaluation Domains?
  • Has Patient Experience Changed Over Time in FHTs (2009–10 to 2012)?
  • Has Patient Experience in CHCs and FHGs Changed Over Time? Have Some Models Improved More Than Others?
  • Does Patient Experience Differ in FHTs, CHCs, and FHGs at Follow Up (2012)?
  • Have FHT Structural and Organizational Characteristics Changed Over Time 2009 to 2012)?
  • What Structural and Organizational Characteristics Are Most Associated With Higher Patient Experience Scores at Follow Up? What Structural and Organizational Characteristics Are Associated With the Best- and Lowest-Performing FHTs?
  • Taking Into Account the Performance of FHTs at Baseline, What Structural and Organizational Characteristics Are Associated With the Most Substantial Improvement, Substantial Deterioration, or Lack of Change (Maintenance of High or Continued Low Performance) in Patient Experience From Baseline to Follow Up?

Chapter 5—Conclusion

Appendix A—Evaluation Framework

Appendix B—Evaluation Methodology

  • Mixed-Methods Design
  • Evaluation Domains
  • Survey Design and Implementation
  • Qualitative Methods Design and Interviews
  • Data Preparation
  • Data Analysis Methodology

Appendix C—Patient Domain Components, Scales, and Scores, 2012

Appendix D—Overall and Domain Patient Experience Scores for FHTs, CHCs, and FHGs, 2009–10 and 2012

Appendix E—Comparative Patient Experience Scores for FHTs, CHCs, and FHGs, 2012

Appendix F—FHT Structural and Organizational Characteristics, 2009 and 2012

Appendix G—Structural and Organizational Characteristics Most Associated With Patient Experience at Follow Up

  • FHT Structural and Organizational Characteristics That Most Differentiate FHTs in the Top Third from FHTs in the Bottom Third Based on Patient Experience in 2012

Appendix H—Structural and Organizational Characteristics Associated With Consistent Patient Experiences and Changes in Patient Experience Over Time

  • FHT Structural and Organizational Characteristics That Most Differentiate Patient Experience Over Time in Quantitative Analyses
  • FHT Structural and Organizational Characteristics Associated With Greater Improvements in Patient Experience Over Time in Quantitative Analyses

Appendix I—Bibliography

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