Abstract:
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Context: In previous work on the quantitative outcomes of Patient-Centered Medical Home (PCMH) transformation in Michigan, we demonstrated cost and quality improvements correlated with PCMH score. Others have reported failing to find reduced ED and hospital utilization among PCMH practices. Objective: If the PCMH reduces hospital and ED utilization, the effect should be specific to conditions targeted by the PCMH: high-prevalence chronic diseases managed largely in primary care. We tested whether the benefit we demonstrated for PCMH transformation was specific to ED and hospital utilization for angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, and hypertension - the conditions targeted for care management in the PCMH model. Design: Quantitative observational study, jointly modeling PCMH-targeted and other hospital admissions and ED visits on PCMH score, patient, and practice characteristics in an hierarchical multivariate model using the generalized gamma distribution.
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