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Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study.

Publication ,  Journal Article
Rosland, A-M; Wong, E; Maciejewski, M; Zulman, D; Piegari, R; Fihn, S; Nelson, K
Published in: Health Serv Res
August 2018

OBJECTIVE: To examine associations between clinics' extent of patient-centered medical home (PCMH) implementation and improvements in chronic illness care quality. DATA SOURCE: Data from 808 Veterans Health Administration (VHA) primary care clinics nationwide implementing the Patient Aligned Care Teams (PACT) PCMH initiative, begun in 2010. DESIGN: Clinic-level longitudinal observational study of clinics that received training and resources to implement PACT. Clinics varied in the extent they had PACT components in place by 2012. DATA COLLECTION: Clinical care quality measures reflecting intermediate outcomes and care processes related to coronary artery disease (CAD), diabetes, and hypertension care were collected by manual chart review at each VHA facility from 2009 to 2013. FINDINGS: In adjusted models containing 808 clinics, the 77 clinics with the most PACT components in place had significantly larger improvements in five of seven chronic disease intermediate outcome measures (e.g., BP < 160/100 in diabetes), ranging from 1.3 percent to 5.2 percent of the patient population meeting measures, and two of eight process measures (HbA1c measurement, LDL measurement in CAD) than the 69 clinics with the least PACT components. Clinics with moderate levels of PACT components showed few significantly larger improvements than the lowest PACT clinics. CONCLUSIONS: Veterans Health Administration primary care clinics with the most PCMH components in place in 2012 had greater improvements in several chronic disease quality measures in 2009-2013 than the lowest PCMH clinics.

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Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

August 2018

Volume

53

Issue

4

Start / End Page

2503 / 2522

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Quality Improvement
  • Patient-Centered Care
  • Patient Care Team
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rosland, A.-M., Wong, E., Maciejewski, M., Zulman, D., Piegari, R., Fihn, S., & Nelson, K. (2018). Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. Health Serv Res, 53(4), 2503–2522. https://doi.org/10.1111/1475-6773.12805
Rosland, Ann-Marie, Edwin Wong, Matthew Maciejewski, Donna Zulman, Rebecca Piegari, Stephan Fihn, and Karin Nelson. “Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study.Health Serv Res 53, no. 4 (August 2018): 2503–22. https://doi.org/10.1111/1475-6773.12805.
Rosland A-M, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, et al. Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. Health Serv Res. 2018 Aug;53(4):2503–22.
Rosland, Ann-Marie, et al. “Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study.Health Serv Res, vol. 53, no. 4, Aug. 2018, pp. 2503–22. Pubmed, doi:10.1111/1475-6773.12805.
Rosland A-M, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, Nelson K. Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. Health Serv Res. 2018 Aug;53(4):2503–2522.
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

August 2018

Volume

53

Issue

4

Start / End Page

2503 / 2522

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Quality Improvement
  • Patient-Centered Care
  • Patient Care Team
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Humans