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Patient‐Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study
Author(s) -
Rosland AnnMarie,
Wong Edwin,
Maciejewski Matthew,
Zulman Donna,
Piegari Rebecca,
Fihn Stephan,
Nelson Karin
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12805
Subject(s) - medicine , medical home , observational study , pact , family medicine , health care , population , chronic care , chronic disease , primary care , environmental health , history , economic growth , archaeology , economics
Objective To examine associations between clinics’ extent of patient‐centered medical home ( PCMH ) implementation and improvements in chronic illness care quality. Data Source Data from 808 Veterans Health Administration ( VHA ) primary care clinics nationwide implementing the Patient Aligned Care Teams ( PACT ) PCMH initiative, begun in 2010. Design Clinic‐level longitudinal observational study of clinics that received training and resources to implement PACT . Clinics varied in the extent they had PACT components in place by 2012. Data Collection Clinical care quality measures reflecting intermediate outcomes and care processes related to coronary artery disease ( CAD ), diabetes, and hypertension care were collected by manual chart review at each VHA facility from 2009 to 2013. Findings In adjusted models containing 808 clinics, the 77 clinics with the most PACT components in place had significantly larger improvements in five of seven chronic disease intermediate outcome measures (e.g., BP < 160/100 in diabetes), ranging from 1.3 percent to 5.2 percent of the patient population meeting measures, and two of eight process measures (HbA1c measurement, LDL measurement in CAD ) than the 69 clinics with the least PACT components. Clinics with moderate levels of PACT components showed few significantly larger improvements than the lowest PACT clinics. Conclusions Veterans Health Administration primary care clinics with the most PCMH components in place in 2012 had greater improvements in several chronic disease quality measures in 2009–2013 than the lowest PCMH clinics.