Do Patient‐Centered Medical Homes Reduce Emergency Department Visits?

David, Guy; Gunnarsson, Candace; Saynisch, Philip; Chawla, Ravi; Nigam, Somesh

doi:10.1111/1475-6773.12218

Cited by 99 publications

(76 citation statements)

References 24 publications

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“…7,8 Early evidence suggests that medical homes have the potential to improve the quality of chronic disease prevention and management [9][10][11][12] and reduce medical utilization. [11][12][13] During the last decade, more than three-quarters of family physicians in Ontario, Canada, have transitioned from a traditional fee-for-service practice to a medical home that incorporates blended capitation payment and, in some cases, funding for nonphysician health professionals. 14 Transitioning to a medical home was voluntary for both physicians and their patients.…”

Section: Introductionmentioning

confidence: 99%

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Kiran

Kopp

Glazier

2016

The Annals of Family Medicine

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PURPOSE Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes. METHODSWe used administrative data for diabetes monitoring and cancer screening to compare services received by patients attached to a medical home (n = 10,785,687) with services received by those seeing a fee-for-service physician (n = 1,321,800) in Ontario, Canada, on March 31, 2011. We used Poisson regression to examine associations in 2011 after adjustment for patient factors and also assessed changes in outcomes between 2001 and 2011.RESULTS Patients attached to a fee-for-service physician were more likely to be immigrants and live in a low-income neighborhood and urban area. They were less likely to receive recommended testing for diabetes (25% vs 34%; adjusted relative risk [RR] = 0.74; 95% CI, 0.73-0.75) and less likely to receive screening for cervical (52% vs 66%; adjusted RR = 0.79; 95% CI, 0.79-0.79), breast (58% vs 73%; adjusted RR = 0.80; 95% CI, 0.80-0.81), and colorectal cancer (44% vs 62%; adjusted RR = 0.72; 95% CI, 0.71-0.72) compared with patients attached to a medical home physician in 2011. These differences in quality of care preceded medical home reforms.CONCLUSION Patients left behind from medical home reforms are more likely to be poor, urban, and new immigrants and receive lower quality care. Strategies are needed to reach out to these patients and their physicians to reduce gaps in care. Ann Fam Med 2016;14:517-525. doi: 10.1370/afm.2000. INTRODUCTIONH ealth systems with strong primary care have better outcomes, lower costs, and fewer disparities.1 Widespread implementation of the medical home is seen as a promising way to improve primary care. [2][3][4][5] In a medical home, practices provide care to a population of patients using a multidisciplinary team approach. Other core features include enhanced access for patients, care coordination, and a focus on quality and safety. 6 Payment reform is an essential element of a medical home and requires shifting physicians from fee-for-service remuneration to capitation or blended payments. 7,8 Early evidence suggests that medical homes have the potential to improve the quality of chronic disease prevention and management [9][10][11][12] and reduce medical utilization. 11-13During the last decade, more than three-quarters of family physicians in Ontario, Canada, have transitioned from a traditional fee-for-service practice to a medical home that incorporates blended capitation payment and, in some cases, funding for nonphysician health professionals.14 Transitioning to a medical home was voluntary for both physicians and their patients. Remuneration in a medical home was generally higher than in fee-for-service practice, so physicians had a financial incentive to join. 15 In contrast to traditional fee-for-service, where physicians ran independent offices akin to small bu...

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Section: Introductionmentioning

confidence: 99%

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Kiran

Kopp

Glazier

2016

The Annals of Family Medicine

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“…[1][2][3][4][5][6][7][8] However, studies with a different design-those comparing practices that have achieved medical home recognition to those that have not-have found more consistent associations between practice transformation and improvements in the quality and efficiency of care, patient experience, and provider satisfaction. [9][10][11][12][13][14] This apparent discrepancy might be explained by barriers that prevent some intervention participants from successfully transforming into medical homes. For example, such transformation may require substantial financial investments that are beyond the reach of some primary care practices.…”

Section: Introductionmentioning

confidence: 99%

Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot

et al. 2015

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“…[24][25][26][27] Flottemesch and colleagues found PCMH clinical practice systems were associated with lower inpatient and emergency department use, as well as lower outpatient and total costs only among patients taking seven or more medications. 25 Higgins and colleagues found non-significant associations between adoption of PCMH and total costs, and hospitalization overall masked significant reductions among patients in the highest risk decile.…”

Section: Discussionmentioning

confidence: 99%

Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden

et al. 2016

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BACKGROUND:The patient-centered medical home (PCMH) model has several components to improve care for patients with high comorbidity, including greater access to face-to-face primary care. OBJECTIVE: We examined whether high-comorbidity patients had larger increases in primary care provider (PCP) visits attributable to PCMH implementation in a large integrated health system relative to other patients enrolled in primary care. DESIGN, SUBJECTS AND MAIN MEASURES: This longitudinal study examined a 1 % random sample of 9.3 million patients enrolled in the Veterans Health Administration (VHA) at any time between 2003 and 2013. Faceto-face visits with PCPs per quarter were identified through VHA administrative data. Comorbidity was measured using the Gagne index and patients with a weighted score of ≥ 2 were defined as high comorbidity. We applied interrupted time-series models to estimate marginal changes in PCP visits attributable to PCMH implementation. Differences in marginal changes were calculated across comorbidity groups (high vs. low). Analyses were stratified by age group to account for Medicare eligibility. KEY RESULTS: Among age 65+ patients, PCMH was associated with greater PCP visits starting four and ten quarters following implementation for high-and lowcomorbidity patients, respectively. Changes were larger for high-comorbidity patients (eight to 11 greater visits per 1000 patients per quarter). Among patients age < 65, PCMH was associated with greater visits for highcomorbidity patients starting eight quarters following implementation, but fewer visits for low-comorbidity patients in all quarters. The difference in visit changes across groups ranged from 18 to 67 visits per 1000 patients per quarter. CONCLUSIONS: Increases in PCP visits attributable to PCMH were greater among patients with higher comorbidity. Health systems implementing PCMH should account for population-level comorbidity burden when planning for PCMH-related changes in PCP utilization.

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Do Patient‐Centered Medical Homes Reduce Emergency Department Visits?

Cited by 99 publications

References 24 publications

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot

Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden

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