nach oben

Erschienen in:

01.04.2020 | Review

Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review

verfasst von: Clark A. Veet, MD, Thomas R. Radomski, MD, MS, Christopher D’Avella, MD, Inmaculada Hernandez, PharmD, PhD, Charles Wessel, MLS, Elizabeth C. S. Swart, BS, William H. Shrank, MD, MSHS, Natasha Parekh, MD, MS

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

As healthcare reimbursement shifts from being volume to value-focused, new delivery models aim to coordinate care and improve quality. The patient-centered medical home (PCMH) model is one such model that aims to deliver coordinated, accessible healthcare to improve outcomes and decrease costs. It is unclear how the types of delivery systems in which PCMHs operate differentially impact outcomes. We aim to describe economic, utilization, quality, clinical, and patient satisfaction outcomes resulting from PCMH interventions operating within integrated delivery and finance systems (IDFS), government systems including Veterans Administration, and non-integrated delivery systems.

Methods

We searched PubMed, the Cochrane Library, and Embase from 2004 to 2017. Observational studies and clinical trials occurring within the USA that met PCMH criteria (as defined by the Agency for Healthcare Research and Quality), addressed ambulatory adults, and reported utilization, economic, clinical, processes and quality of care, or patient satisfaction outcomes.

Results

Sixty-four studies were included. Twenty-four percent were within IDFS, 29% were within government systems, and 47% were within non-IDFS. IDFS studies reported decreased emergency department use, primary care use, and cost relative to other systems after PCMH implementation. Government systems reported increased primary care use relative to other systems after PCMH implementation. Clinical outcomes, processes and quality of care, and patient satisfaction were assessed heterogeneously or infrequently.

Discussion

Published articles assessing PCMH interventions generally report improved outcomes related to utilization and cost. IDFS and government systems exhibit different outcomes relative to non-integrated systems, demonstrating that different health systems and populations may be particularly sensitive to PCMH interventions. Both the definition of PCMH interventions and outcomes measured are heterogeneous, limiting the ability to perform direct comparisons or meta-analysis.

Nur mit Berechtigung zugänglich

Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation. Washington (DC) National Academies Press (US)

Assurance NCfQ;Pageshttps://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/ on June 1 2019.

Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, et al. The patient centered medical home. A systematic review. Ann Intern Med 2013;158(3):169–78.PubMed

Solberg LI, Crain AL, Tillema JO, Fontaine PL, Whitebird RR, Flottemesch TJ, et al. Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders. J Am Board Fam Med 2014;27(4):449–57.PubMed

Enthoven AC. Integrated delivery systems: the cure for fragmentation. Am J Manag Care 2009;15(10 Suppl):S284–90.PubMed

Johnson G, Lyon ZM, Frakt A. Provider-Offered Medicare Advantage Plans: Recent Growth And Care Quality. Health Aff 2017;36(3):539–47.

Parekh N, Hernandez I, Radomski TR, Shrank WH. Relationships between provider-led health plans and quality, utilization, and satisfaction. Am J Manag Care 2018;24(12):628–32.PubMed

Yano EM, Bair MJ, Carrasquillo O, Krein SL, Rubenstein LV. Patient Aligned Care Teams (PACT): VA’s journey to implement patient-centered medical homes. J Gen Intern Med 2014;29 Suppl 2:S547–9.PubMed

Werner RM, Canamucio A, Shea JA, True G. The medical home transformation in the Veterans Health Administration: an evaluation of early changes in primary care delivery. Health Serv Res 2014;49(4):1329–47.PubMedPubMedCentral

10.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.CrossRef

11.

Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. 2012;Pages http://www.ohrica/programs/clinical_epidemiology/oxfordasp on June 26 2019.

12.

Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, et al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. Jama 2016;316(8):826–34.PubMed

13.

Reid RJ, Johnson EA, Hsu C, Ehrlich K, Coleman K, Trescott C, et al. Spreading a medical home redesign: effects on emergency department use and hospital admissions. Ann Fam Med 2013;11 Suppl 1:S19–26.PubMedPubMedCentral

14.

Rosenberg CN, Peele P, Keyser D, McAnallen S, Holder D. Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption of the model. Health Aff. 2012;31(11):2423–31.

15.

Fishman PA, Johnson EA, Coleman K, Larson EB, Hsu C, Ross TR, et al. Impact on seniors of the patient-centered medical home: evidence from a pilot study. Gerontologist 2012;52(5):703–11.PubMedPubMedCentral

16.

Gilfillan RJ, Tomcavage J, Rosenthal MB, Davis DE, Graham J, Roy JA, et al. Value and the medical home: effects of transformed primary care. Am J Manag Care. 2010;16(8):607–14. 16PubMed

17.

Reid RJ, Fishman PA, Yu O, Ross TR, Tufano JT, Soman MP, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care 2009;15(9):e71–87.PubMed

18.

O’Toole TP, Johnson EE, Aiello R, Kane V, Pape L. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis 2016;13:E44.PubMedPubMedCentral

19.

Andrews CA, Northam S, Gosselin K. Evaluation of an Innovative Program To Improve Outcomes among Military Beneficiaries with Diabetes. Nurs Econ 2015;33(5):271–80.PubMed

20.

Fandre M, McKenna C, Beauvais B, Kim F, Mangelsdorff AD. Patient-centered medical home implementation effects on emergency room utilization: a case study. Hosp Top 2014;92(3):59–65.PubMed

21.

Smith JJ, Johnston JM, Hiratsuka VY, Dillard DA, Tierney S, Driscoll DL. Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients. Prim Care Diabetes 2015;9(2):120–6.PubMed

22.

Johnston JM, Smith JJ, Hiratsuka VY, Dillard DA, Szafran QN, Driscoll DL. Tribal implementation of a patient-centred medical home model in Alaska accompanied by decreased hospital use. Int J Circumpolar Health 2013;72.

23.

Newman RJ, Bikowski R, Nakayama K, Cunningham T, Acker P, Bradshaw D. Outcomes of Embedded Care Management in a Family Medicine Residency Patient-Centered Medical Home. Fam Med 2017;49(1):46–51.PubMed

24.

Cuellar A, Helmchen LA, Gimm G, Want J, Burla S, Kells BJ, et al. The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years. J Gen Intern Med 2016;31(11):1382–8.PubMedPubMedCentral

25.

Rosenthal MB, Alidina S, Friedberg MW, Singer SJ, Eastman D, Li Z, et al. A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot. J Gen Intern Med 2016;31(3):289–96.PubMed

26.

Carrillo JE, Carrillo VA, Guimento R, Mucaria J, Leiman J. The NewYork-Presbyterian Regional Health Collaborative: a three-year progress report. Health Aff. 2014;33(11):1985–92.

27.

Carrillo JE, Shekhani NS, Deland EL, Fleck EM, Mucaria J, Guimento R, et al. A regional health collaborative formed By NewYork-Presbyterian aims to improve the health of a largely Hispanic community. Health Aff. 2011;30(10):1955–64.

28.

Roby DH, Pourat N, Pirritano MJ, Vrungos SM, Dajee H, Castillo D, et al. Impact of patient-centered medical home assignment on emergency room visits among uninsured patients in a county health system. Med Care Res Rev 2010;67(4):412–30.PubMed

29.

Randall I, Mohr DC, Maynard C. VHA Patient-Centered Medical Home Associated With Lower Rate of Hospitalizations and Specialty Care Among Veterans With Posttraumatic Stress Disorder. J Healthc Qual 2015.

30.

O’Toole TP, Buckel L, Bourgault C, Blumen J, Redihan SG, Jiang L, et al. Applying the chronic care model to homeless veterans: effect of a population approach to primary care on utilization and clinical outcomes. Am J Public Health. 2010;100(12):2493–9. 17PubMedPubMedCentral

31.

Edes T, Kinosian B, Vuckovic NH, Olivia Nichols L, Mary Becker M, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc 2014;62(10):1954–61.PubMed

32.

Romanelli RJ, Leahy A, Jukes T, Ishisaka DY. Pharmacist-led medication management program within a patient-centered medical home. Am J Health Syst Pharm 2015;72(6):453–9.PubMed

33.

Yoon J, Chow A, Rubenstein LV. Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs. Med Care 2016;54(2):118–25.PubMed

34.

Kern LM, Edwards A, Kaushal R. The Patient-Centered Medical Home and Associations With Health Care Quality and Utilization: A 5-Year Cohort Study. Ann Intern Med 2016;164(6):395–405.PubMed

35.

Maeng DD, Khan N, Tomcavage J, Graf TR, Davis DE, Steele GD. Reduced acute inpatient care was largest savings component of Geisinger Health System’s patient-centered medical home. Health Aff. 2015;34(4):636–44.

36.

Maeng DD, Graham J, Graf TR, Liberman JN, Dermes NB, Tomcavage J, et al. Reducing long-term cost by transforming primary care: evidence from Geisinger’s medical home model. Am J Manag Care 2012;18(3):149–55.PubMed

37.

Hebert PL, Liu CF, Wong ES, Hernandez SE, Batten A, Lo S, et al. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12. Health Aff. 2014;33(6):980–7.

38.

Schubert CC, Myers LJ, Allen K, Counsell SR. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed. J Am Geriatr Soc 2016;64(7):1503–9.PubMed

39.

Shane DM, Nguyen-Hoang P, Bentler SE, Damiano PC, Momany ET. Medicaid Health Home Reducing Costs and Reliance on Emergency Department: Evidence From Iowa. Med Care 2016;54(8):752–7.PubMed

40.

Jones C, Finison K, McGraves-Lloyd K, Tremblay T, Mohlman MK, Tanzman B, et al. Vermont’s Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care. Popul Health Manag 2016;19(3):196–205.PubMedPubMedCentral

41.

Fillmore H, DuBard CA, Ritter GA, Jackson CT. Health care savings with the patient-centered medical home: Community Care of North Carolina’s experience. Popul Health Manag 2014;17(3):141–8.PubMedPubMedCentral

42.

Maeng DD, Graf TR, Davis DE, Tomcavage J, Bloom FJ. Can a patient-centered medical home lead to better patient outcomes? The quality implications of Geisinger’s ProvenHealth Navigator. Am J Med Qual 2012;27(3):210–6.PubMed

43.

Katon W, Russo J, Lin EH, Schmittdiel J, Ciechanowski P, Ludman E, et al. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Arch Gen Psychiatry 2012;69(5):506–14.PubMed

44.

Liss DT, Fishman PA, Rutter CM, Grembowski D, Ross TR, Johnson EA, et al. Outcomes among chronically ill adults in a medical home prototype. Am J Manag Care 2013;19(10):e348–58.PubMedPubMedCentral

45.

Graham J, Bowen TR, Strohecker KA, Irgit K, Smith WR. Reducing mortality in hip fracture patients using a perioperative approach and “Patient- Centered Medical Home” model: a prospective cohort study. Patient Saf Surg. 2014;8(1):7. 18PubMedPubMedCentral

46.

Bekelman DB, Plomondon ME, Carey EP, Sullivan MD, Nelson KM, Hattler B, et al. Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial. JAMA Intern Med 2015;175(5):725–32.PubMed

47.

O’Toole TP, Pirraglia PA, Dosa D, Bourgault C, Redihan S, O’Toole MB, et al. Building care systems to improve access for high-risk and vulnerable veteran populations. J Gen Intern Med 2011;26 Suppl 2:683–8.PubMedPubMedCentral

48.

Hassaballa I, Ebekozien O, Ogungbadero A, Williams F, Schultz J, Hunter-Skidmore J, et al. Evaluation of a diabetes care coordination program for African-American women living in public housing. J Clin Outcomes Manag 2015;22(8):365–72.

49.

Eisenstat SA, Chang Y, Porneala BC, Geagan E, Wilkins G, Chase B, et al. Development and Implementation of a Collaborative Team Care Model for Effective Insulin Use in an Academic Medical Center Primary Care Network. Am J Med Qual. 2016.

50.

Green BB, Anderson ML, Chubak J, Baldwin LM, Tuzzio L, Catz S, et al. Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH). J Am Board Fam Med 2016;29(2):191–200.PubMedPubMedCentral

51.

Rosenthal MB, Alidina S, Friedberg MW, Singer SJ, Eastman D, Li Z, et al. Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs. Med Care Res Rev 2016;73(5):532–45.PubMed

52.

Rosenthal MB, Sinaiko AD, Eastman D, Chapman B, Partridge G. Impact of the Rochester Medical Home Initiative on Primary Care Practices, Quality, Utilization, and Costs. Med Care 2015;53(11):967–73.PubMed

53.

Page TF, Amofah SA, McCann S, Rivo J, Varghese A, James T, et al. Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients. Health Promot Pract 2015;16(4):609–16.PubMed

54.

Rosenthal MB, Friedberg MW, Singer SJ, Eastman D, Li Z, Schneider EC. Effect of a multipayer patient-centered medical home on health care utilization and quality: the Rhode Island chronic care sustainability initiative pilot program. JAMA Intern Med 2013;173(20):1907–13.PubMed

55.

Werner RM, Duggan M, Duey K, Zhu J, Stuart EA. The patient-centered medical home: an evaluation of a single private payer demonstration in New Jersey. Med Care 2013;51(6):487–93.PubMed

56.

Fifield J, Forrest DD, Burleson JA, Martin-Peele M, Gillespie W. Quality and efficiency in small practices transitioning to patient centered medical homes: a randomized trial. J Gen Intern Med 2013;28(6):778–86.PubMedPubMedCentral

57.

Gabbay RA, Bailit MH, Mauger DT, Wagner EH, Siminerio L. Multipayer patient-centered medical home implementation guided by the chronic care model. Jt Comm J Qual Patient Saf 2011;37(6):265–73.PubMed

58.

Maeng DD, Davis DE, Tomcavage J, Graf TR, Procopio KM. Improving patient experience by transforming primary care: evidence from Geisinger’s patient-centered medical homes. Popul Health Manag 2013;16(3):157–63.PubMed

59.

Christensen EW, Dorrance KA, Ramchandani S, Lynch S, Whitmore CC, Borsky AE, et al. Impact of a patient-centered medical home on access, quality, and cost. Mil Med. 2013;178(2):135–41. 19PubMed

60.

Schmidt LA, Rittenhouse DR, Wu KJ, Wiley JA. Transforming primary care in the New Orleans safety-net: the patient experience. Med Care 2013;51(2):158–64.PubMed

61.

Heyworth L, Bitton A, Lipsitz SR, Schilling T, Schiff GD, Bates DW, et al. Patient-centered medical home transformation with payment reform: patient experience outcomes. Am J Manag Care 2014;20(1):26–33.PubMed

62.

Hochman ME, Asch S, Jibilian A, Chaudry B, Ben-Ari R, Hsieh E, et al. Patient-centered medical home intervention at an internal medicine resident safety-net clinic. JAMA Intern Med 2013;173(18):1694–701.PubMedPubMedCentral

63.

David G, Gunnarsson C, Saynisch PA, Chawla R, Nigam S. Do patient-centered medical homes reduce emergency department visits? Health Serv Res 2015;50(2):418–39.PubMed

64.

Peikes D, Zutshi A, Genevro JL, Parchman ML, Meyers DS. Early evaluations of the medical home: building on a promising start. Am J Manag Care 2012;18(2):105–16.PubMed

65.

Paustian ML, Alexander JA, El Reda DK, Wise CG, Green LA, Fetters MD. Partial and incremental PCMH practice transformation: implications for quality and costs. Health Serv Res 2014;49(1):52–74.PubMed

66.

Sommers BD, Epstein AM. Why states are so miffed about Medicaid--economics, politics, and the “woodwork effect”. N Engl J Med 2011;365(2):100–2.PubMed

67.

Yoon J, Liu CF, Lo J, Schectman G, Stark R, Rubenstein LV, et al. Early changes in VA medical home components and utilization. Am J Manag Care 2015;21(3):197–204.PubMed

68.

Magill MK, Ehrenberger D, Scammon DL, Day J, Allen T, Reall AJ, et al. The cost of sustaining a patient-centered medical home: experience from 2 states. Ann Fam Med 2015;13(5):429–35.PubMedPubMedCentral

Titel: Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review
verfasst von: Clark A. Veet, MD
Thomas R. Radomski, MD, MS
Christopher D’Avella, MD
Inmaculada Hernandez, PharmD, PhD
Charles Wessel, MLS
Elizabeth C. S. Swart, BS
William H. Shrank, MD, MSHS
Natasha Parekh, MD, MS
Publikationsdatum: 01.04.2020
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 4/2020
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05594-3

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

24.04.2024 | DGIM 2024 | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review

Abstract

Background

Methods

Results

Discussion

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Background

Methods

Results

Discussion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2020

The Code Switch

Sutton’s Law, Substance Use Disorder, and Treatment of Hepatitis C in the Era of Direct-acting Antivirals

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

The Partnership to Improve Diabetes Education Trial: a Cluster Randomized Trial Addressing Health Communication in Diabetes Care

Health Technology Assessment Centers—an Infrastructure for Health Systems to Translate Evidence into Practice

Federal Barriers to Addressing the Opioid Epidemic

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Update Innere Medizin