Patient-Reported Access in the Patient-Centered Medical Home and Avoidable Hospitalizations: an Observational Analysis of the Veterans Health Administration

Abstract

BACKGROUND:The Patient-Centered Medical Home (PCMH) has emphasized timely access to primary care, often by using non-traditional modes of delivery, such as care in person after-hours or by phone during or after normal hours. Limited data exists on whether improving patient-reported access with these service types reduces hospitalization. OBJECTIVE: To examine the association of patientreported access to primary care within the Veteran Health Administration (VHA) via five service types and hospitalizations for ambulatory care sensitive conditions (ACSCs). DESIGN: Retrospective cohort study, using multivariable logistic regression adjusting for patient demographics, comorbidity, characteristics of patients' area of residence, and clinic-level random effects. PARTICIPANTS: A total of 69,710 VHA primary care patients who responded to the 2012 Survey of Healthcare Experiences of Patients (SHEP), PCMH module. MAIN MEASURES: Survey questions captured patients' ability to obtain care from VHA for five service types: routine care, immediate care, after-hours care, care by phone during regular office hours, and care by phone after normal hours. Outcomes included binary measures of hospitalization for overall, acute, and chronic ACSCs in 2013, identified in VHA administrative data and Medicare feefor-service claims. KEY RESULTS: Patients who reported Balways^able to obtain after-hours care compared to Bnever^were less likely to be hospitalized for chronic ACSCs (OR 0.62, 95% CI 0.44-0.89, p = 0.009). Patients reporting Busually^getting care by phone during regular hours were more likely have a hospitalization for chronic ACSC (OR 1.49, 95% CI 1.03-2.17, p = 0.034). Experiences with routine care, immediate care, and care by phone after-hours demonstrated no significant association with hospitalization for ACSCs. CONCLUSIONS: Improving patients' ability to obtain after-hours care was associated with fewer hospitalizations for chronic ACSCs, while access to care by phone during regular hours was associated with more hospitalizations. Health systems should consider the benefits, including reduced hospitalizations for chronic ACSCs, against the costs of implementing each of these PCMH services.

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

“…Worldwide, health systems face financial pressure from increasing utilization of hospital-based services and expenditures, which are often unplanned, undesirable and avoidable [ 1 – 3 ]. As a fundamental element of the healthcare delivery system, primary care facilities (PCFs) play a vital role in the care coordination and the transition to specialized care [ 2 , 4 ].…”

Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality

“…Existing evidence supports the role of PCPs and the patient-PCP relationship in improving chronic disease control and reducing emergency department visits through better preventive care and disease management to prevent adverse outcomes. [ 34 – 36 ] A similar pattern could also be at work among COVID-19 patients and how a relationship with primary care impacts the examined outcomes.…”

Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China

“…Increased access to and affordability of medical service have made it easier for patients with serious illness and their families to seek help from hospitals, which might cause the overuse of hospital-based care and aggravate the financial burden for family members and the health care system [ 26 ]. A fragmented health care system leads to increased medical expenditures and other negative patient outcomes [ 27 , 28 ]. Understanding the interplay between residential rurality, the type of caregiver, and the place of death and their association with EOL medical expenditures is critical to inform policy enaction and implementation.…”