TY - JOUR
KW - health system science
KW - healthcare delivery models
KW - patient-centered medical home
AU - C. A. Veet
AU - T. R. Radomski
AU - C. D'Avella
AU - I. Hernandez
AU - C. Wessel
AU - E. C. S. Swart
AU - W. H. Shrank
AU - N. Parekh
A1 - 
AB - 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.
AD - Department of Medicine Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA. veetca@upmc.edu.; Department of Medicine Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.; Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA.; Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA.; UPMC Center for High-Value Healthcare, UPMC Insurance Services Division, Pittsburgh, PA, USA.; Humana, Louisville, KY, USA.; The Queen's Health System, Honolulu, HI, USA.
BT - Journal of general internal medicine
C5 - Financing & Sustainability; Medical Home
CY - United States
DO - 10.1007/s11606-019-05594-3
JF - Journal of general internal medicine
M1 - Journal Article
N2 - 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.
PP - United States
PY - 2020
SN - 1525-1497; 0884-8734
T1 - Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review
T2 - Journal of general internal medicine
TI - Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review
U1 - Financing & Sustainability; Medical Home
U2 - 31907790
U3 - 10.1007/s11606-019-05594-3
VO - 1525-1497; 0884-8734
Y1 - 2020
Y2 - Jan 6
ER -