Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida
| Autor: | Andrew Brickman, Allyson G. Hall, Sweta Tewary, Heidi Kinsell, Jeffrey S. Harman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Multivariate analysis Impact evaluation Logistic regression Body Mass Index 0302 clinical medicine Patient-Centered Care Outcome Assessment Health Care Medicine health outcomes 030212 general & internal medicine Longitudinal Studies Disease management (health) Original Research access to care 030503 health policy & services lcsh:Public aspects of medicine Age Factors Hispanic or Latino Middle Aged Florida lcsh:R858-859.7 Female 0305 other medical science Medical home Adult medicine.medical_specialty impact evaluation Medicare lcsh:Computer applications to medicine. Medical informatics Vulnerable Populations White People Odds 03 medical and health sciences primary care Diabetes mellitus Diabetes Mellitus community health centers patient-centeredness Humans Aged Quality of Health Care Community and Home Care Glycated Hemoglobin business.industry Public Health Environmental and Occupational Health lcsh:RA1-1270 medicine.disease United States Black or African American Logistic Models disease management Blood Preservation Family medicine Multivariate Analysis business Body mass index Delivery of Health Care |
| Zdroj: | Journal of Primary Care & Community Health, Vol 8 (2017) Journal of Primary Care & Community Health |
| ISSN: | 2150-1327 2150-1319 |
| Popis: | Objective Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. Methods We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Results Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Conclusion Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups. |
| Databáze: | OpenAIRE |
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