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

Table 7 Quality of evidence assessment

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 indirectness^a	No serious inconsistency	Moderate
Process of care	Team-based models	3	Cohort studies	Risk of serious bias	Serious indirectness^a	Serious inconsistency	Low
Process of care	Payment models	6	Before and after and cohort studies	Risk of serious bias	Serious indirectness^b	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

^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
^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

ISSN: 1472-6963