Outcomes Among Chronically Ill Adults in a Medical Home Prototype

Details

• Personal Author:
  Fishman PA ; Grembowski D ; Johnson, Elizabeth A. ; Liss DT ; Reid R ; Ross TR ; Rutter CM
• Description:
  Objectives: To compare quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites. Study Design: Nonequivalent pretest-posttest control group design. Methods: PCMH redesign results were investigated for patients with preexisting diabetes, hypertension, and/or coronary heart disease. Data from automated databases were collected for eligible enrollees in an integrated healthcare delivery system. Multivariable regression models tested for adjusted differences between PCMH patients and controls during the baseline and follow-up periods. Dependent measures under study included clinical processes and, outcomes, monthly healthcare utilization, and costs. Results: Compared with controls over 2 years, patients at the PCMH prototype clinic had slightly better clinical outcome control in coronary heart disease (2.20 mg/dL lower mean low-density lipoprotein cholesterol; P <.001). PCMH patients changed their patterns of primary care utilization, as reflected by 86% more secure electronic message contacts (P <.001), 10% more telephone contacts (P = .003), and 6% fewer in-person primary care visits (P <.001). PCMH patients had 21% fewer ambulatory care-sensitive hospitalizations (P <.001) and 7% fewer total inpatient admissions (P = .002) than controls. During the 2-year redesign, we observed 17% lower inpatient costs (P <.001) and 7% lower total healthcare costs (P <.001) among patients at the PCMH prototype clinic. Conclusions: A clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses. [Description provided by NIOSH]
• Subjects:
  Blood Cardiovascular Diseases Cardiovascular System Chronic Disease Delivery Of Health Care Hematologic Diseases Occupational Health Safety
• Keywords:
  Blood Sugar Disorders Cardiovascular Disease Chronic Diseases Costs Hypertension Medical Care
• ISSN:
  1088-0224
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Illinois ; OSHA Region 10 ; OSHA Region 5 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  19
• Issue:
  10
• NIOSHTIC Number:
  nn:20056902
• Citation:
  Am J Manag Care 2013 Oct; 19(10):e348-e358
• Contact Point Address:
  David T. Liss, PhD, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Dr, 10th Fl, Chicago, IL 60611
• Email:
  david.liss@northwestern.edu
• Federal Fiscal Year:
  2014
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  The American Journal of Managed Care
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d84da229e0eadc705281b7d49a0d3a8dadd864643be17a17642bb93f1fc7970ec4fd33a334a485aa8653290cab066d825ed4475bec5ed63d2c0cb9a876d0b119
• Download URL:
  https://stacks.cdc.gov/view/cdc/214398/cdc_214398_DS1.pdf
• File Type:
  [PDF - 123.27 KB ]