Meredith B. Rosenthal1, Shehnaz Alidina2,1, Mark W. Friedberg2,3,4, Sara J. Singer3,1,5, Diana Eastman1, Zhonghe Li1, Eric C. Schneider2,3,1,4
1Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Brigham and Women’s Hospital, Boston, MA, USA
3Harvard Medical School, Boston, MA, USA
4RAND Corporation, Boston, MA, USA
5Massachusetts General Hospital, Boston, MA, USA
Tóm tắt
To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio, that participated in the Aligning Forces for Quality Multi-Payer Patient Centered Medical Home pilot. Our research design involved difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot practices compared with those attributed to a matched comparison cohort after 2 years of active engagement by the practices. The Cincinnati pilot was associated with a reduction of ambulatory care–sensitive emergency department visits of approximately 0.7 per 1,000 member months or approximately 22.6% ( p = .01). While there was a reduction in total costs of care of $7,679 per 1,000 member months, the difference did not reach statistical significance. After 2 years of the pilot, lipid testing in diabetics had increased by 2.7 percentage points (a 3.3% improvement; p < .0001). Patient-centered medical homes have the potential to improve the quality of care and reduce emergency department use but expectations for cost control in a relatively short time horizon and absent other changes may be unrealistic.
