The Impact of Comprehensive Pre-visit Preparation on Patient Engagement and Quality of Care in a Population of Underserved Patients with Diabetes: Evidence from the Care Management Medical Home Center Model

Abstract

This study evaluated the impact of pre-visit preparation, a key component of Patient-Centered Medical Home guidelines, on compliance with recommended tests and screenings in a diabetic patient population receiving care in Federally Qualified Health Centers in Miami-Dade County. The pre-visit preparation consisted of a pre-visit phone call to review patient compliance with recommended tests and screenings, provide encouragement for self-care goal setting, answer patient questions, assure referrals and tests were scheduled, and notify an in-center patient care team about which services are required at the upcoming visit. Aggregated data from 7 health centers and a cohort analysis of 7491 patients showed significantly higher compliance among those who were successfully contacted prior to the visit compared to those who were not successfully contacted at 24 months for all compliance measures included in the study. These results included a 28.8 percentage point difference in compliance with HbA1c testing, a 14.6 percentage point difference in influenza immunization, a 27.7 percentage point difference in diabetic foot exam compliance, and a 33.2 percentage point difference in compliance with annual low-density lipoprotein testing. After 24 months, the patient no-show rate decreased by 6.8 percentage points (from 20.7% to 14.0%) among contacted patients and by 5.5 percentage points (from 20.7% to 15.2%) among patients who were not contacted. Study results suggest that proactive pre-visit preparation may be a key strategy for primary care practices to improve areas critical for chronic disease management, such as patient engagement, appointments kept, and compliance with recommended screenings, tests, and services. (Population Health Management 2016;19:171-177).

Do Patient‐Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low‐Income Patients? A Systematic Review and Meta‐Analysis

“…Follow-up and adherence were generally better in cases. Of the six studies that assessed follow-up/adherence, only one showed lower levels of follow-up/adherence in the experimental group (Rivo et al 2016) and this study's essentially showed no effect for follow-up/adherence. An intermediate effect size (0.500 to 0.700) was found in three studies.…”

“…; : diabetes patient outcomes) and quality of care (Rivo et al. : diabetes patient outcomes with previsit interventions).…”

“…The majority of studies either tested interventions funded by state Medicaid programs (13 studies) or the Commonwealth Fund (six studies) (see Appendix SA3). As stated in Table 1, there were a total of ten RCTs (Counsell et al 2006(Counsell et al , 2007Lee et al 2009;Weaver et al 2009;Doty et al 2010;Schmidt et al 2013;Sen et al 2014;Stevens et al 2014Stevens et al , 2015Pyne et al 2015), nine case/control studies (Landon et al 2007;Counsell et al 2009;Coleman and Phillips 2010;Gilmer 2011;Hochman et al 2013;Wheeler et al 2013;Chu et al 2016;Rhodes et al 2016;Shane et al 2016), nine longitudinal studies (Chin et al 2007;Balaban et al 2008;Chan et al 2009;Rittenhouse et al 2012;Congdon et al 2013;Beadles et al 2015;Maeng et al 2016;Rivo et al 2016;Sabik et al 2016), and five cross-sectional studies (Gill et al 2005;Roby et al 2010;Lewis et al 2012;Solberg et al 2014).…”

“…However, there does appear to be a significant level of improvement when it comes to ER utilization (mean d = À0.205, range À0.530 to À0.016) and cost in one study. A couple of studies show a higher effect when it came to followup (Stevens et al 2014; : diabetes patient outcomes) and quality of care (Rivo et al 2016: diabetes patient outcomes with previsit interventions).…”

Organizational Factors in Patient-Centered Medical Home Implementation and Chronic Disease Management in HRSA-Funded Community Health Centers

“…CHCs (Lieberthal et al, 2017;Rivo et al, 2016;Dobbins et al, 2018). According to Rivo et al (2016), PCMH-related aspects such as comprehensive care, coordinated care, and patient engagement are key to addressing these conditions, as well as managing patient populations.…”