Estimating Associations Between Medical Home Adoption, Utilization, and Quality
A Comparison of Evaluation Approaches
Bibliographic Data
| ID | 9103584 |
|---|---|
| Authors | Grant R Martsolf (0000-0003-1942-8683, RAND Corporation, Pittsburgh, PA, corresponding author), Ryan Kandrack (0000-0001-7091-384X, RAND Corporation, Pittsburgh, PA, corresponding author), Matthew Baird (0000-0001-8785-0865, RAND Corporation, Pittsburgh, PA), Matthew D Baird (0000-0003-3016-480X, RAND Corporation, corresponding author), Mark W Friedberg (0000-0002-7907-8358, RAND Corporation) |
| Year | 2018 |
| Volume | 56 |
| Issue | 1 |
| Pages | 25-30 |
| Publication date | 2018-01-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000842 |
| PMID | 29189577 |
| OpenAlex | W2769753206 |
| Language | EN |
| Citations received | 2 |
| References cited | 17 |
BACKGROUND: Methodological differences between evaluations of medical home adoption might complicate readers' ability to draw conclusions across studies. OBJECTIVES: To study whether associations between medical home adoption and patient care are affected by methodological choices. DESIGN, SETTING, AND SUBJECTS: Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of "medical home adoption" [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality. MEASUREMENTS: Six utilization and 6 quality measures. RESULTS: In cross-sectional analyses at year 3, NCQA recognition was associated with higher rates of nephropathy monitoring (7.23 percentage points; confidence interval, 0.45-14.02), breast cancer screening (7.48; 2.11-12.86), and colorectal cancer screening (8.43; 2.44-14.42). In longitudinal analyses, NCQA recognition was associated with increases in hospitalization rates (2.75 per 1000 patient-months; 0.52-4.98). In baseline cross-sectional analyses, higher Medical Home Index scores were associated with fewer ambulatory care-sensitive hospitalizations (-0.61 per 1000 patient per month; -1.11 to -0.11), all-cause emergency department visits (-6.80; -12.28 to -1.32), and ambulatory care-sensitive emergency department visits (-5.60; 10.32 to -0.88). There were no statistically significant associations between any other measure of medical home adoption and quality or utilization. CONCLUSIONS: The findings of medical home evaluations are sensitive to methodological choices. Meta-analyses, narrative reviews, and other syntheses of medical home studies should consider subdividing their findings by analytic approach
Ambulatory · Ambulatory care · Confidence interval · Cross-sectional study · Emergency department · Family medicine · Health care · Medical home · Primary care · Chronic Disease Management Strategies · Emergency Medicine · Healthcare Policy and Management · Medicine · Nursing · Primary Care and Health Outcomes · Gerontology
| Unique citing works | 2 |
|---|---|
| Citations per year | 0,4 |
| Citation span | 2021 - 2023 (3) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 2 |