Patient-centered medical home model improves chronic disease management

November 20, 2017, University of Pittsburgh Schools of the Health Sciences
Bar graph showing statistically significant changes in percentage of PACT clinic populations meeting clinical guidelines. Credit: University of Pittsburgh

Data from more than 800 Veterans Health Administration (VHA) primary care clinics revealed that national implementation of a patient-centered medical home model was effective at improving several chronic disease outcomes over time. Findings were published online today in Health Services Research.

The VHA launched its Patient Aligned Care Teams (PACT) initiative in 2010, the largest program in the country to implement patient-centered medical home care. The VHA assigned each of the network's 5 million primary care to a "teamlet" designed to provide multidisciplinary health care support focused on patients' individual needs. Similar models are being implemented and tested in health systems across the country.

Over the course of four years, a team of researchers led by Ann-Marie Rosland, M.D., associate professor of internal medicine, University of Pittsburgh School of Medicine, analyzed medical records from all 808 participating clinics to measure 15 clinical outcomes and clinical processes to determine how the PACT model influenced care for patients with coronary artery disease, diabetes and hypertension. These three common and costly chronic diseases can lead to significant complications and disability if they are not controlled.

All VHA clinics were given access to the same resources, tools and training to implement the PACT model, which addresses eight areas of care: access, continuity, coordination, team-based care, comprehensiveness of care, self-management support, patient-centered communication and shared decision-making. No control group was designated, but some clinics had naturally implemented more elements of the program than others by 2012, and analyses adjusted and accounted for various differences among the high and low implementation clinics.

The 77 clinics that most fully executed the PACT model by 2012 had significantly larger improvements in five of seven chronic disease outcome measures and two of eight clinical process measures compared to the 69 clinics with the fewest PACT elements implemented. Researchers found that clinics with the most advanced PACT implementation saw 1 to 5 percent more of their patients meeting established levels for diabetes, blood pressure and cholesterol control.

"Most studies of comprehensive medical home models have not been able to assess the impact they have on the control of chronic conditions, such as whether patients are bringing their sugar levels down to recommended goals. They have been able to look only at whether doctors and nurses are following recommended processes, such as whether sugar levels are being checked in the clinic," said Rosland, who also has an appointment at the VA Pittsburgh Center for Health Equity Research and Promotion. "All VHA primary care patients were provided with PACT's team-based care, and we were able to identify that this model of care, when well-implemented, translated into better outcomes for patients with chronic conditions.

"While not every clinical measure improved as significantly as others with increased implementation of the PACT model, this study demonstrates that systems that invest in changes in care delivery through a medical home for all primary care patients could see downstream improvements in the management of those patients with ," added Rosland.

Explore further: AAFP spells out conditions for retail clinics

Related Stories

AAFP spells out conditions for retail clinics

August 10, 2015
(HealthDay)—Retail clinics have a place in the health care marketplace, but they must meet conditions relating to continuity of care, according to the American Academy of Family Physicians (AAFP).

ACP provides guidelines for retail health clinics

October 13, 2015
(HealthDay)—Retail clinics have a place in health care and should encourage the longitudinal care relationship with primary care physicians, according to a position paper published online Oct. 12 in the Annals of Internal ...

Patient satisfaction high with nurse-led chronic kidney Dz care

February 8, 2017
(HealthDay)—For patients with chronic kidney disease (CKD), patient satisfaction is high with care at nurse-led clinics, according to a study published online Feb. 3 in the Journal of Renal Care.

Implementing large-scale teleretinal diabetic retinopathy screening program

March 27, 2017
Can a large-scale, primary care-based teleretinal diabetic retinopathy screening (TDRS) program reduce wait times for screening and improve the timeliness of care in the Los Angeles County Department of Health Services, the ...

Retail clinics best used as backup to a patient's primary care physician

October 13, 2015
The American College of Physicians (ACP) today said that retail health clinics - now commonly present in drugstores and/or big box retailers - are best used as a backup alternative to a patient's primary care physician for ...

Chronic care coordinators improve diabetes monitoring but not blood sugar control

November 12, 2014
Getting support from a chronic care coordinator increases blood-glucose testing and foot and eye exams in people with type 2 diabetes, but it may not improve blood-sugar control, a new study in the journal Health Services ...

Recommended for you

Don't eat bitter pumpkin, study warns after women lose hair

May 25, 2018
A doctor warned Friday that bitter-tasting pumpkins and squashes can contain potent toxins, after two women were poisoned by their dinners and lost most of their hair.

Hot cars can hit deadly temperatures in as little as one hour

May 24, 2018
A lot can happen at 160 degrees Fahrenheit: Eggs fry, salmonella bacteria dies, and human skin will suffer third-degree burns. If a car is parked in the sun on a hot summer day, its dashboard can hit 160 degrees in about ...

Research finds a little exercise does a lot of good for ageing muscles

May 24, 2018
Getting old doesn't necessarily mean getting weak and frail – just a little bit of exercise can help maintain muscle mass and strength, Otago research has revealed.

In helping smokers quit, cash is king, e-cigarettes strike out

May 23, 2018
Free smoking cessation aids, such as nicotine patches and chewing gum, are a staple of many corporate wellness programs aimed at encouraging employees to kick the habit. But, new research shows that merely offering such aids ...

What makes us well? Diversity, health care, and public transit matter

May 23, 2018
Diverse neighbors. Health centers. Commuter trains. These community attributes, and other key factors, are linked to well-being and quality of life, according to Yale researchers.

Widely used e-cigarette flavoring impairs lung function

May 23, 2018
A new study has found that a common e-cigarette flavoring that has chemical characteristics similar to toxic chemicals found in cigarette smoke disrupts an important mechanism of the lungs' antibacterial defense system. The ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.