TY - JOUR
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Emergency Service, Hospital/economics/utilization
KW - Female
KW - Health Expenditures/statistics & numerical data
KW - Health Services/economics/utilization
KW - Hospitalization/economics/statistics & numerical data
KW - Humans
KW - Longitudinal Studies
KW - Male
KW - Mental Health Services/economics/utilization
KW - Middle Aged
KW - Patient-Centered Care/statistics & numerical data
KW - Primary Health Care/statistics & numerical data
KW - Quality Improvement/statistics & numerical data
KW - Socioeconomic Factors
KW - United States
KW - United States Department of Veterans Affairs
AU - J. Yoon
AU - A. Chow
AU - L. V. Rubenstein
A1 - 
AB - BACKGROUND: Evidence-based quality improvement (EBQI) methods may facilitate practice redesign for more effective implementation of the patient-centered medical home (PCMH). OBJECTIVE: We assessed changes in health care utilization and costs for patients receiving care from practices using an EBQI approach to implement PCMH and comparison practices over a 5-year period. RESEARCH DESIGN: We used longitudinal, electronic data from patients in 6 practices using EBQI and 28 comparison practices implementing standard PCMH for 1 year before and 4 years after PCMH implementation. We analyzed trends in utilization and costs using bivariate analyses and independent effects of EBQI status on outcomes using multivariate regressions adjusting for year, patient and clinic factors, and patient random effects for repeated measures. SUBJECTS: A total of 136,856 patients using Veterans Affairs primary care. MEASURES: Veterans Affairs ambulatory care encounters, emergency department visits, admissions, and total health care costs per patient. RESULTS: After PCMH implementation, overall utilization for primary care, specialty care, and mental health/substance abuse care decreased, whereas utilization for telephone care increased among all practices. Patients also had fewer hospitalizations and lower costs per patient. In adjusted analyses, EBQI practice was independently associated with fewer primary care (IRR=0.85), specialty care (IRR=0.83), and mental health care encounters (IRR=0.69); these effects attenuated over time (all P<0.01). There was no independent effect of EBQI on prescription drug use, acute care, health care costs, or mortality rate relative to comparison practices. CONCLUSION: EBQI methods enhanced the effects of PCMH implementation by reducing ambulatory care while increasing non-face-to-face care.
BT - Medical care
C5 - Financing & Sustainability; Medical Home
CP - 2
CY - United States
DO - 10.1097/MLR.0000000000000478
IS - 2
JF - Medical care
N2 - BACKGROUND: Evidence-based quality improvement (EBQI) methods may facilitate practice redesign for more effective implementation of the patient-centered medical home (PCMH). OBJECTIVE: We assessed changes in health care utilization and costs for patients receiving care from practices using an EBQI approach to implement PCMH and comparison practices over a 5-year period. RESEARCH DESIGN: We used longitudinal, electronic data from patients in 6 practices using EBQI and 28 comparison practices implementing standard PCMH for 1 year before and 4 years after PCMH implementation. We analyzed trends in utilization and costs using bivariate analyses and independent effects of EBQI status on outcomes using multivariate regressions adjusting for year, patient and clinic factors, and patient random effects for repeated measures. SUBJECTS: A total of 136,856 patients using Veterans Affairs primary care. MEASURES: Veterans Affairs ambulatory care encounters, emergency department visits, admissions, and total health care costs per patient. RESULTS: After PCMH implementation, overall utilization for primary care, specialty care, and mental health/substance abuse care decreased, whereas utilization for telephone care increased among all practices. Patients also had fewer hospitalizations and lower costs per patient. In adjusted analyses, EBQI practice was independently associated with fewer primary care (IRR=0.85), specialty care (IRR=0.83), and mental health care encounters (IRR=0.69); these effects attenuated over time (all P<0.01). There was no independent effect of EBQI on prescription drug use, acute care, health care costs, or mortality rate relative to comparison practices. CONCLUSION: EBQI methods enhanced the effects of PCMH implementation by reducing ambulatory care while increasing non-face-to-face care.
PP - United States
PY - 2016
SN - 1537-1948; 0025-7079
SP - 118
EP - 125
EP - 
T1 - Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs
T2 - Medical care
TI - Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs
U1 - Financing & Sustainability; Medical Home
U2 - 26761727
U3 - 10.1097/MLR.0000000000000478
VL - 54
VO - 1537-1948; 0025-7079
Y1 - 2016
ER -