System Transformation in Patient-Centered Medical Home (PCMH): Variable Impact on Chronically Ill Patients' Utilization

Autor: Leif I. Solberg, Caroline S. Carlin, Ann M. Werner, Thomas J. Flottemesch
Rok vydání: 2016
Předmět:
Adult
Male
Research design
Medical home
medicine.medical_specialty
Cross-sectional study
Minnesota
Comorbidity
Drug Prescriptions
03 medical and health sciences
0302 clinical medicine
Patient-Centered Care
Health care
Ambulatory Care
Diabetes Mellitus
medicine
Humans
030212 general & internal medicine
Disease management (health)
Medical prescription
Intensive care medicine
Aged
business.industry
030503 health policy & services
Public Health
Environmental and Occupational Health
Health Care Costs
Emergency department
Middle Aged
Patient Acceptance of Health Care
Quality Improvement
Hospitalization
Cross-Sectional Studies
Cardiovascular Diseases
Research Design
Family medicine
Chronic Disease
Female
Observational study
Emergency Service
Hospital
0305 other medical science
Family Practice
business
Zdroj: The Journal of the American Board of Family Medicine. 29:482-495
ISSN: 1558-7118
1557-2625
Popis: Background Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. The objective of this study was to examine the association between stage and domain of change and patterns of health care utilization. Methods This was a cross-sectional observational study that including 87 Minnesota clinics certified as medical homes. Patients included those receiving management for diabetes or cardiovascular disease with insurance coverage by payers participating in the study. PCMH transformation stage was defined by practice systems in place, with measurements summarized in 5 domains. Health care utilization was measured by total utilization, frequency of outpatient visits and prescriptions, and occurrence of inpatient and emergency department visits. Results PCMH transformation was associated with few changes in utilization, but there were important differences by the underlying domains of change. We demonstrate meaningful differences in the impact of PCMH transformation by diagnosis cohort and comorbidity status of the patient. Conclusions Because the association of health care utilization with PCMH transformation varied by transformation domain and patient diagnosis, practice leaders need to be supported by research incorporating detailed measures of PCMH transformation.
Databáze: OpenAIRE
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