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Table 7 Quality of evidence assessment

From: The impact of primary care reform on health system performance in Canada: a systematic review

Outcome Reform Number of studies Study design Risk of bias Directness Consistency Overall assessment of the evidence
Health service utilization Team-based models 3 Cohort studies No risk of serious bias Serious indirectnessa No serious inconsistency Moderate
Process of care Team-based models 3 Cohort studies Risk of serious bias Serious indirectnessa Serious inconsistency Low
Payment models 6 Before and after and cohort studies Risk of serious bias Serious indirectnessb Serious inconsistency Low
Physicians costs and productivity Payment models 4 Before and after No risk of serious bias No serious indirectness No serious inconsistency High
  1. aThe main source of indirectness stems from the evaluation of different team-based interventions. Given the small number of studies, we conducted a pooled assessment of the evidence from Alberta and Quebec in order to provide an overall assessment of the evidence
  2. bThe main source of indirectness stems from results on a number of different interventions examined in relation to payment models in Ontario that we pooled in order to provide an overall assessment of the evidence