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- Title
The Reduction in ED and Hospital Admissions in Medical Home Practices Is Specific to Primary Care-Sensitive Chronic Conditions.
- Authors
Green, Lee A.; Chang, Hsiu‐Ching; Markovitz, Amanda R.; Paustian, Michael L.; Chang, Hsiu-Ching
- Abstract
<bold>Objective: </bold>To determine whether the Patient-Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in our setting.<bold>Data Sources and Study Setting: </bold>All patients aged 18 years and older in 2,218 primary care practices participating in a statewide PCMH incentive program sponsored by Blue Cross Blue Shield of Michigan (BCBSM) in 2009-2012.<bold>Study Design: </bold>Quantitative observational study, jointly modeling PCMH-targeted versus other hospital admissions and ED visits on PCMH score, patient, and practice characteristics in a hierarchical multivariate model using the generalized gamma distribution.<bold>Data Collection: </bold>Claims data and PCMH scores held by BCBSM.<bold>Principal Findings: </bold>Both hospital and ED utilization were reduced proportionately to PCMH score. Hospital utilization was reduced by 13.9 percent for PCMH-targeted conditions versus only 3.8 percent for other conditions (p = .003), and ED utilization by 11.2 percent versus 3.7 percent (p = .010). Hospital PMPM cost was reduced by 17.2 percent for PCMH-targeted conditions versus only 3.1 percent for other conditions (p < .001), and ED PMPM cost by 9.4 percent versus 3.6 percent (p < .001).<bold>Conclusions: </bold>PCMH transformation reduces hospital and ED use, and the majority of the effect is specific to PCMH-targeted conditions.
- Subjects
MICHIGAN; PRIMARY care; PATIENT-centered medical homes; ACQUISITION of data; GAMMA distributions; HOSPITAL utilization; CHRONIC disease treatment; COMPARATIVE studies; HOSPITAL care; HOSPITAL emergency services; INSURANCE; HEALTH insurance; RESEARCH methodology; MEDICAL quality control; MEDICAL cooperation; PRIMARY health care; RESEARCH; RESEARCH funding; SEX distribution; RESIDENTIAL patterns; EVALUATION research; PATIENT-centered care
- Publication
Health Services Research, 2018, Vol 53, Issue 2, p1163
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12674