Abstract
Background
As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings.
Objective
We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations.
Design
Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year.
Participants
2,853,030 patients from 814 VHA primary care clinics
Main Measures
Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®.
Key Results
The overall mean home builder score in the study clinics was 88 (SD = 13) or 69 %. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3 % (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074).
Conclusion
Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.
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Acknowledgements
This work was supported by the Department of Veterans Affairs, Veterans Health Administration Office of Research and Development, Health Services Research and Development (grant #: IIR 09–082). Dr. Yano's effort was covered by a VA HSR&D Senior Research Career Scientist Award (Project #RCS 05-195). The authors wish to acknowledge Belinda Black MSPH, Office of Patient Care Services, Veterans Health Administration for administering the clinic survey and Michael Barr MD, MBA, FACP, American College of Physicians for providing valuable comments. Preliminary results from this study were presented at the Academy Health Annual Research Meeting, June 24–26, 2012, in Orlando, FL and the VA Health Services Research and Development Meeting, July 17–19, in Washington, DC.
Disclaimer
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
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The authors declare that they do not have a conflict of interest.
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APPENDIX
APPENDIX
Description of Medical Home Builder Components
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1)
Access and scheduling: Provides scheduling flexibility such as same day appointments and open access scheduling and non face-to-face services.
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Care coordination and transitions in care: Offers individualized treatment plans, assessment of treatment and self-management goals, and has procedures for communication and coordination with other providers and facilities.
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3)
Organization of practice: Tracks procedures, test results, medications, and practices as a team.
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4)
Patient-centered care and communication: Provides support for patients’ self-management and decision-making and staff training in communication.
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5)
Population management: Uses patient registries and clinical guidelines and identifies frequent diagnoses and unmet needs in patients.
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Quality improvement and performance improvement: Uses performance measures, satisfaction surveys, and other measures of quality.
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7)
Use of technology: Uses practice management systems, electronic health records, and decision support systems.
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Yoon, J., Rose, D.E., Canelo, I. et al. Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations. J GEN INTERN MED 28, 1188–1194 (2013). https://doi.org/10.1007/s11606-013-2405-5
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DOI: https://doi.org/10.1007/s11606-013-2405-5