Model Homes: Evaluating Approaches to Patient-centered Medical Home Implementation.
Med Care
; 59(3): 206-212, 2021 03 01.
Article
en En
| MEDLINE
| ID: mdl-33480657
ABSTRACT
BACKGROUND:
The patient-centered medical home (PCMH) model has been widely adopted, but the evidence on its effectiveness remains mixed. One potential explanation for these mixed findings is variation in how the model is implemented by practices.OBJECTIVE:
To identify the impact of different approaches to PCMH adoption on health care utilization in a long-term, geographically diverse sample of patients.DESIGN:
Difference-in-differences evaluation of PCMH impact on cost and utilization.SUBJECTS:
A total of 5,314,284 patient-year observations from the HealthCore Integrated Research Database, and 5943 practices which adopted the PCMH model in 14 states between 2011 and 2015. INTERVENTION PCMH adoption, as defined by the National Committee for Quality Assurance. MEASUREMENTS Six claims-based utilization measures, plus total health care expenditures. We employ hierarchical clustering to organize practices into groups based on their PCMH capabilities, then use generalized difference-in-differences models with practice or patient fixed effects to estimate the effect of PCMH recognition (overall and separately by the groups identified by the clustering algorithm) on utilization.RESULTS:
PCMH adoption was associated with a >8% reduction in total expenditures. We find significant reductions in emergency department utilization and outpatient care, and both lab and imaging services. In our by-group results we find that while the reduction in outpatient care is significant across all 3 groups, the reduction in emergency department utilization is driven entirely by 1 group with enhanced electronic communications.CONCLUSION:
The PCMH model has significant impact on patterns of health care utilization, especially when heterogeneity in implementation is accounted for in program evaluation.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Grupo de Atención al Paciente
/
Atención Primaria de Salud
/
Calidad de la Atención de Salud
/
Atención Dirigida al Paciente
Tipo de estudio:
Evaluation_studies
/
Prognostic_studies
Aspecto:
Implementation_research
Límite:
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Med Care
Año:
2021
Tipo del documento:
Article