In the Journals

Medical home intervention led to improvements in care

A 3-year medical home intervention was associated with improvements in quality of care, increased primary care utilization and lower use of the ED, hospital and specialty care, according to study results.

“More than 100 medical home interventions are under way in the United States. They vary considerably in the mix of new resources, technical assistance, contractual obligations, performance measures and incentives available to primary care practices,” Mark W. Friedberg, MD, MPP, of the division of general internal medicine at Brigham and Women’s Hospital, and colleagues wrote.

The researchers quantified the association between involvement in the Northeastern Pennsylvania Chronic Care Initiative and changes in quality and care usage. The initiative lasted for 36 months and consisted of two commercial health plans and 27 volunteer small primary care practice sites. Medical claims data were assessed for 17,363 patients attributed to 27 pilot practices (recognized as medical homes) and 29 comparison practices.

Primary outcome measures were performance on six quality measures for diabetes and preventive care; and use of hospital, ED and ambulatory care.

When compared with 3-year performance results for comparison practices, pilot practices resulted in significantly better performance outcomes for four process measures of diabetes care and breast cancer screening.

In addition, pilot practices were associated with lower rates for all-cause hospitalizations (8.5 per 1,000 patients per month vs. 10.2 per 1,000 patients per month; difference, – 1.7; 95% CI, – 3.2 to – 0.03), all-cause ED visits (29.5 per 1,000 patients per month vs. 34.2 per 1,000 patients per month; difference, – 4.7; 95%CI, – 8.7 to – 0.9), ambulatory care–sensitive ED visits (16.2 per 1,000 patients per month vs. 19.4 per 1,000 patients per month; difference, – 3.2; 95% CI, – 5.7 to – 0.9) and ambulatory visits to specialists (104.9 per 1,000 patients per month vs. 122.2 per 1,000 patients per month; difference, – 17.3; 95% CI, – 26.6 to – 8). Pilot practices were also associated with higher rates for ambulatory primary care visits (349 per 1,000 patients per month vs. 271.5 per 1,000 patients per month; difference, 77.5; 95% CI, 37.3-120.5).

“We believe evaluation results from the first 3 years of the northeast Pennsylvania Chronic Care Initiative offer guidance for program designers and policymakers. With further experimentation and evaluation, such interventions may continue to become more effective,” Friedberg and colleagues wrote. – by Jennifer Southall

Disclosures: Friedberg reports receiving compensation for consultation from the United States Department of Veterans Affairs and research support from Patient-Centered Outcomes Research Institute via subcontract to the National Committee for Quality Assurance. Please see the full study for a list of all other authors’ relevant financial disclosures.

A 3-year medical home intervention was associated with improvements in quality of care, increased primary care utilization and lower use of the ED, hospital and specialty care, according to study results.

“More than 100 medical home interventions are under way in the United States. They vary considerably in the mix of new resources, technical assistance, contractual obligations, performance measures and incentives available to primary care practices,” Mark W. Friedberg, MD, MPP, of the division of general internal medicine at Brigham and Women’s Hospital, and colleagues wrote.

The researchers quantified the association between involvement in the Northeastern Pennsylvania Chronic Care Initiative and changes in quality and care usage. The initiative lasted for 36 months and consisted of two commercial health plans and 27 volunteer small primary care practice sites. Medical claims data were assessed for 17,363 patients attributed to 27 pilot practices (recognized as medical homes) and 29 comparison practices.

Primary outcome measures were performance on six quality measures for diabetes and preventive care; and use of hospital, ED and ambulatory care.

When compared with 3-year performance results for comparison practices, pilot practices resulted in significantly better performance outcomes for four process measures of diabetes care and breast cancer screening.

In addition, pilot practices were associated with lower rates for all-cause hospitalizations (8.5 per 1,000 patients per month vs. 10.2 per 1,000 patients per month; difference, – 1.7; 95% CI, – 3.2 to – 0.03), all-cause ED visits (29.5 per 1,000 patients per month vs. 34.2 per 1,000 patients per month; difference, – 4.7; 95%CI, – 8.7 to – 0.9), ambulatory care–sensitive ED visits (16.2 per 1,000 patients per month vs. 19.4 per 1,000 patients per month; difference, – 3.2; 95% CI, – 5.7 to – 0.9) and ambulatory visits to specialists (104.9 per 1,000 patients per month vs. 122.2 per 1,000 patients per month; difference, – 17.3; 95% CI, – 26.6 to – 8). Pilot practices were also associated with higher rates for ambulatory primary care visits (349 per 1,000 patients per month vs. 271.5 per 1,000 patients per month; difference, 77.5; 95% CI, 37.3-120.5).

“We believe evaluation results from the first 3 years of the northeast Pennsylvania Chronic Care Initiative offer guidance for program designers and policymakers. With further experimentation and evaluation, such interventions may continue to become more effective,” Friedberg and colleagues wrote. – by Jennifer Southall

Disclosures: Friedberg reports receiving compensation for consultation from the United States Department of Veterans Affairs and research support from Patient-Centered Outcomes Research Institute via subcontract to the National Committee for Quality Assurance. Please see the full study for a list of all other authors’ relevant financial disclosures.