Differences in Diabetes Care With and Without Certification as a Medical Home

Abstract

PURPOSE The purpose of this study was to assess whether primary care practices certified as medical homes differ in having the practice systems required for that designation and in attaining favorable outcomes for their patients with diabetes, and whether those systems are associated with better diabetes outcomes.METHODS We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 Minnesota adult primary care practices, comparing those that were certified vs uncertified as medical homes in 2017, with analyses supplemented by previously published studies of these practices. We collected survey information about the presence of medical home practice systems for diabetes care and obtained 6 standardized measures of diabetes care collected yearly from all Minnesota practices. RESULTSOf 416 practices completing questionnaires (71% of all practices, 92% of participating practices), 394 had data on diabetes care measures. Uncertified practices (39%) were more likely than certified practices to be rural, but their patient populations were similar. Certified practices had more medical home practice systems (79.2% vs 74.9%, P =.01) and were more likely to meet a composite measure of optimal diabetes care (46.8% vs 43.2%, P <.001). A 1-SD increase in presence of practice systems was associated with a 1.4% higher probability of meeting that measure (P <.001).CONCLUSIONS Practices certified as medical homes have more practice systems and higher performance on diabetes care than uncertified practices, but there is extensive overlap, and any differences may reflect self-selection for certification.

Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study

“…We began with quantitative methods to assess primary care performance based on consistently reported practice outcomes for patients with diabetes in relation to variables like medical group size, practice context ( i . e ., urban/rural) [ 12 ], and medical home certification [ 7 , 27 ]. Through this work the study team identified associations between care management processes and quality.…”

“…Given the UNITED study’s focus on identifying specific changeable factors and strategies that are most effective in producing high-quality outcome scores, selection was limited to practices that performed in the top quartile statewide on the composite of the five diabetes quality measures for the most recent year with available data (2018). Selection further included only those practices that returned the Physician Practice Connections–Research Survey in both 2017 and 2019; collected as part of the UNITED study’s mixed-method approach, this survey was used to assess a practice’s systematic use of care management processes [ 7 , 8 , 12 ].…”

“…The Understanding Infrastructure Transformation Effects on Diabetes (UNITED) study is a mixed methods study examining how primary care practices organize the delivery of care for patients with diabetes and produce high quality clinical outcomes. The UNITED study quantitatively compared most primary care practices across the state according to standardized quality measures collected yearly for public performance reports [ 7 ]. The UNITED study had also planned qualitative assessments of practice performance by conducting three rounds of interviews with practice leaders.…”

Strategies and Factors Associated With Top Performance in Primary Care for Diabetes: Insights From a Mixed Methods Study

“…6 Quantitative analyses of this data set have been published. 7,8 Quantitative Data Study participation depended on having a clinic leader complete a 112-question survey in 2017 regarding the presence of various care management processes to support high-quality care for patients with chronic medical conditions. The survey was created and tested for reliability by the National Committee for Quality Assurance and has been widely used.…”

Provider Network Structure and Black-to-White Disparity Gaps for Medicare Patients with Diabetes: County-Level Analysis of Cost, Utilization, and Clinical Care

“…[4][5][6][7] Primary care physicians (PCP) care for over 90% of individuals with type 2 diabetes, and recent findings indicate that PCP centric structures that align with the medical home model appear well suited for improving care and outcomes for this patient population. [8][9][10] While these findings are still primarily based on observational studies, related work assessing the effect of Accountable Care Organizations on patient care has indicated evidence of a potential causal link between organizational structure and patient outcomes. 11 With that noted, not all patients receive care in PCP centric structures, and many are instead confronted with fragmented care delivery, which has been shown to reduce quality of care, increase utilization, increase cost, and lead to poorer outcomes.…”