Patient-Centered Medical Home Implementation and Use of Preventive Services

Markovitz, Amanda R; Alexander, Jeffrey A.; Lantz, Paula M.; Paustian, Michael L.

doi:10.1001/jamainternmed.2014.8263

Cited by 46 publications

(35 citation statements)

References 48 publications

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“…In prior studies, the association between reported NCQA recognition and improvement in screening rates has been unclear, with some showing a positive association between PCMH practice redesign and higher screening rates, 12,14,15 while other studies have reported no change in breast or cervical cancer screening quality outcomes with medical home interventions. 11,13,16 One reason for these inconsistent findings may be a lack of uniformity in system changes required for NCQA recognition.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] As HIT and practice management are incorporated into clinical practice, often as part of establishing a patient-centered medical home (PCMH), recent studies have evaluated the relationship of practice factors and system design to cancer screening quality indicators. 12,[14][15][16] Characteristics such as the number of providers in the practice have been associated with adoption of systems and HIT in support of cancer screening. 17 However, adoption of HIT systems at the practice level does not ensure that physicians will make use of them.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have reported improvement in cancer screening rates following the adoption of a PCMH model. 12,14,15 However, others have reported no change in cancer screening quality outcomes. 11,13,16 Although adoption of the PCMH has been most prevalent in the primary care specialties of general internal medicine, family medicine, and pediatrics, other fields such as obstetrics and gynecology (OB/ GYN) may consider primary care as part of their scope of practice and may benefit from similar systems.…”

Section: Introductionmentioning

confidence: 99%

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Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

et al. 2016

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BACKGROUND: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. OBJECTIVE: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patientcentered medical home (PCMH). DESIGN: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. PARTICIPANTS: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. MAIN MEASURES: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. KEY RESULTS: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guidelineadherent breast (OR 3.23,

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

et al. 2016

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“…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. …”

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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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“…Patient-centered medical homes (PCMHs) have been associated with increased use of preventive services, though it is not clear whether health and financial outcomes are affected. [4][5][6] Accountable Care Organizations (ACOs), when combined with PCMHs, may empower primary care and incentivize change, 7 and ACO shared-savings contracts may encourage hospital systems and specialty providers to become vested stakeholders in evidence-based prevention. Preventive care quality measures and incentives in ACO contracts might assure that prevention is pri-oritized while participants pursue strategies to reduce the cost of care.…”

Section: Introductionmentioning

confidence: 99%

Updated Priorities Among Effective Clinical Preventive Services

et al. 2017

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PURPOSEThe Patient Protection and Affordable Care Act's provisions for firstdollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODSWe assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures-cost-effectiveness and clinically preventable burden-for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTSThe 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesityrelated behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations.CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives. 2017;15:14-22. https://doi.org/10.1370/afm.2017. Ann Fam Med INTRODUCTIONT he landscape for prevention in primary care has changed dramatically since the Committee on Clinical Preventive Service Priorities published the first ranking of clinical preventive services in 2001, 1 and the National Commission on Prevention Priorities (NCPP) last updated the list in 2006. 2 A growing evidence base has expanded knowledge about effective preventive services. At the same time, the Patient Protection and Affordable Care Act (ACA) and the pursuit of the Triple Aim 3 seek to expand access to and the efficiency of primary care.Changes in primary care have potential to improve utilization of preventive services. Patient-centered medical homes (PCMHs) have been associated with increased use of preventive services, though it is not clear whether health and financial outcomes are affected. [4][5][6] Accountable Care Organizations (ACOs), when combined with PCMHs, may empower primary care and incentivize change, 7 and ACO shared-savings contracts may encourage hospital systems and specialty providers to become vested stakeholders in evidence-based prevention. Preventive care quality measures and incentives in ACO contracts might ass...

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Patient-Centered Medical Home Implementation and Use of Preventive Services

Cited by 46 publications

References 48 publications

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

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

Updated Priorities Among Effective Clinical Preventive Services

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