Model Homes: Evaluating Approaches to Patient-centered Medical Home Implementation.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
23
1
2021
medline:
7
5
2021
entrez:
22
1
2021
Statut:
ppublish
Résumé
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. To identify the impact of different approaches to PCMH adoption on health care utilization in a long-term, geographically diverse sample of patients. Difference-in-differences evaluation of PCMH impact on cost and utilization. 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. PCMH adoption, as defined by the National Committee for Quality Assurance. 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. 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. The PCMH model has significant impact on patterns of health care utilization, especially when heterogeneity in implementation is accounted for in program evaluation.
Sections du résumé
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.
Identifiants
pubmed: 33480657
doi: 10.1097/MLR.0000000000001497
pii: 00005650-202103000-00004
pmc: PMC7993910
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
206-212Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
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