The impact of patient‐centered medical home certification on quality of care for patients with diabetes

Abstract

Objective: To identify the impact of changes surrounding certification as a patientcentered medical home (PCMH) on outcomes for patients with diabetes. Study Setting: Minnesota legislation established mandatory quality reporting for patients with diabetes and statewide standards for certification as a PCMH. Patientlevel quality reporting data (2008-2018) were used to study the impact of transition to a PCMH. Study Design: Achievement of Minnesota's optimal diabetes care standard-in aggregate and by component-was modeled for adult patients with Type 1 or Type 2 diabetes as a function of time relative to the year the patient's primary care practice achieved PCMH certification. Patients from uncertified practices were used to control for general trend. Practice-level random effects captured time-invariant characteristics of practices and the practices' average patient. Data Collection: Electronic health record data were submitted by 695 Minnesota practices capturing components of the quality standard: blood sugar control, cholesterol control, blood pressure control, nonsmoking status, and use of aspirin.

Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study

“…We began with quantitative methods to assess primary care performance based on consistently reported practice outcomes for patients with diabetes in relation to variables like medical group size, practice context ( i . e ., urban/rural) [ 12 ], and medical home certification [ 7 , 27 ]. Through this work the study team identified associations between care management processes and quality.…”

“…In striving to identify specific changeable factors and strategies that are most effective in producing high quality outcome scores, the UNITED study proposed a mixed methods explanatory sequential design. We began with quantitative methods to assess primary care performance based on consistently reported practice outcomes for patients with diabetes in relation to variables like medical group size, practice context (i.e., urban/rural) [12], and medical home certification [7,27]. Through this work the study team identified associations between care management processes and quality.…”

Unpacking the patient‐centered medical home

“…PCMH models are seldom directly incentivized to lower costs, but many practices may use the PCMH as a stepping stone to participating in an accountable care organization, where practices can share in savings generated after quality thresholds are met. 10 It is therefore no surprise that studies like Carlin et al 3 that focused their analysis on the quality of care for patients with diabetes after state legislation created a population-based registry of diabetes care measures or Hinde et al 11 that examined spillover effects of a Medicaid PCMH to private payers, have found that early adopters of the PMCH may be considerably different from those that took several years to implement the model. These early practices may have operated as a PCMH prior to official recognition and continue to do so afterward; the PCMH seal of approval may allow them to gain recognition from their health system or others of this status but not otherwise make meaningful changes.…”

“…This model of care has received considerable attention in the health service literature, with almost 1500 publications as of this writing that use this term in PubMed alone. Yet one of the many lessons in Carlin et al 3 is that the PCMH is not a single model of care, but a broad set of definitions that are recognized by a number of organizations, including the National Committee for Quality Assurance, AHRQ, states such as Minnesota and North Carolina, payers, and various provider/practice organizations 4 . However, being recognized as a PCMH involves its own process, which can be costly to practices 5,6 without a direct long‐term reward.…”

“…What may be more surprising, however, are the many examples where practice transformation to the PCMH resulted in improved health outcomes and even lower costs. Carlin et al 3 find significant improvements in diabetes care outcomes concentrated among practices that were not recognized as PCMHs in the first four years of MN’s program, but instead may have needed more time to meet the multidimensional criteria to be recognized as a PCMH through actual practice changes.…”