TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Child
KW - Community Health Centers/organization & administration/statistics & numerical data
KW - Health Personnel/organization & administration
KW - Humans
KW - Middle Aged
KW - Models, Organizational
KW - Patient-Centered Care/organization & administration/statistics & numerical data
KW - Primary Health Care/organization & administration/statistics & numerical data
KW - Socioeconomic Factors
KW - Workforce/organization & administration
KW - Young Adult
AU - J. Park
AU - X. Wu
AU - B. K. Frogner
AU - P. Pittman
A1 - 
AB - BACKGROUND: Few studies have looked under the hood of practice redesign to understand whether and, if so, how staffing changed with the adoption of patient-centered medical home (PCMH), and whether these staffing changes impacted utilization. OBJECTIVES: To examine the workforce transformation occurring in community health centers that have achieved PCMH status, and to assess the relationship of those changes to utilization, as measured by the number of visits. RESEARCH DESIGN, SUBJECTS, MEASURES: Using a difference-in-differences approach, we compared staffing and utilization outcomes in 450 community health centers that had adopted a PCMH model between 2007 and 2013 to a matched sample of 243 nonadopters located in the 50 states and the District of Columbia. RESULTS: We found that adopting a PCMH model was significantly associated with a growth in use of advanced practice staff (nurse practitioners and physician assistants) [0.53 full-time equivalent (FTE), 8.77%; P<0.001], other medical staff (medical assistants, nurse aides, and quality assurance staff) (1.23 FTE, 7.46%; P=0.001), mental health/substance abuse staff (0.73 FTE, 17.63%; P=0.005), and enabling service staff (case managers and health educators) (0.36 FTE, 6.14%; P=0.079), but not primary care physicians or nurses. We did not observe a significant increase in utilization, as measured in total number of visits per year. However, the visits marginally attributed to advanced practice staff (539 FTE, 0.89%; P=0.037) and mental health/substance abuse staff (353 FTE, 0.59%; P=0.051) significantly increased. CONCLUSIONS: Our findings suggest that the implementation of PCMH actively reengineers staff composition and this, in turn, results in changes in marginal utilization by each staff type.
AD - School of Nursing, The George Washington University.; Department of Health Policy and Management, GW Health Workforce Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC.; Department of Family Medicine, UW Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle, WA.; Department of Health Policy and Management, GW Health Workforce Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC.
BT - Medical care
C5 - Financing & Sustainability; Medical Home
CP - 9
CY - United States
DO - 10.1097/MLR.0000000000000965
IS - 9
JF - Medical care
M1 - Journal Article
N2 - BACKGROUND: Few studies have looked under the hood of practice redesign to understand whether and, if so, how staffing changed with the adoption of patient-centered medical home (PCMH), and whether these staffing changes impacted utilization. OBJECTIVES: To examine the workforce transformation occurring in community health centers that have achieved PCMH status, and to assess the relationship of those changes to utilization, as measured by the number of visits. RESEARCH DESIGN, SUBJECTS, MEASURES: Using a difference-in-differences approach, we compared staffing and utilization outcomes in 450 community health centers that had adopted a PCMH model between 2007 and 2013 to a matched sample of 243 nonadopters located in the 50 states and the District of Columbia. RESULTS: We found that adopting a PCMH model was significantly associated with a growth in use of advanced practice staff (nurse practitioners and physician assistants) [0.53 full-time equivalent (FTE), 8.77%; P<0.001], other medical staff (medical assistants, nurse aides, and quality assurance staff) (1.23 FTE, 7.46%; P=0.001), mental health/substance abuse staff (0.73 FTE, 17.63%; P=0.005), and enabling service staff (case managers and health educators) (0.36 FTE, 6.14%; P=0.079), but not primary care physicians or nurses. We did not observe a significant increase in utilization, as measured in total number of visits per year. However, the visits marginally attributed to advanced practice staff (539 FTE, 0.89%; P=0.037) and mental health/substance abuse staff (353 FTE, 0.59%; P=0.051) significantly increased. CONCLUSIONS: Our findings suggest that the implementation of PCMH actively reengineers staff composition and this, in turn, results in changes in marginal utilization by each staff type.
PP - United States
PY - 2018
SN - 1537-1948; 0025-7079
SP - 784
EP - 790
EP - 
T1 - Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers?
T2 - Medical care
TI - Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers?
U1 - Financing & Sustainability; Medical Home
U2 - 30015722
U3 - 10.1097/MLR.0000000000000965
VL - 56
VO - 1537-1948; 0025-7079
Y1 - 2018
Y2 - Sep
ER -