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01-04-2020 | Care | Review

Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review

Authors: Clark A. Veet, MD, Thomas R. Radomski, MD, MS, Christopher D’Avella, MD, Inmaculada Hernandez, PharmD, PhD, Charles Wessel, MLS, Elizabeth C. S. Swart, BS, William H. Shrank, MD, MSHS, Natasha Parekh, MD, MS

Published in: Journal of General Internal Medicine | Issue 4/2020

Abstract

Background

As healthcare reimbursement shifts from being volume to value-focused, new delivery models aim to coordinate care and improve quality. The patient-centered medical home (PCMH) model is one such model that aims to deliver coordinated, accessible healthcare to improve outcomes and decrease costs. It is unclear how the types of delivery systems in which PCMHs operate differentially impact outcomes. We aim to describe economic, utilization, quality, clinical, and patient satisfaction outcomes resulting from PCMH interventions operating within integrated delivery and finance systems (IDFS), government systems including Veterans Administration, and non-integrated delivery systems.

Methods

We searched PubMed, the Cochrane Library, and Embase from 2004 to 2017. Observational studies and clinical trials occurring within the USA that met PCMH criteria (as defined by the Agency for Healthcare Research and Quality), addressed ambulatory adults, and reported utilization, economic, clinical, processes and quality of care, or patient satisfaction outcomes.

Results

Sixty-four studies were included. Twenty-four percent were within IDFS, 29% were within government systems, and 47% were within non-IDFS. IDFS studies reported decreased emergency department use, primary care use, and cost relative to other systems after PCMH implementation. Government systems reported increased primary care use relative to other systems after PCMH implementation. Clinical outcomes, processes and quality of care, and patient satisfaction were assessed heterogeneously or infrequently.

Discussion

Published articles assessing PCMH interventions generally report improved outcomes related to utilization and cost. IDFS and government systems exhibit different outcomes relative to non-integrated systems, demonstrating that different health systems and populations may be particularly sensitive to PCMH interventions. Both the definition of PCMH interventions and outcomes measured are heterogeneous, limiting the ability to perform direct comparisons or meta-analysis.

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Title: Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review
Authors: Clark A. Veet, MD
Thomas R. Radomski, MD, MS
Christopher D’Avella, MD
Inmaculada Hernandez, PharmD, PhD
Charles Wessel, MLS
Elizabeth C. S. Swart, BS
William H. Shrank, MD, MSHS
Natasha Parekh, MD, MS
Publication date: 01-04-2020
Publisher: Springer International Publishing
Keyword: Care
Published in: Journal of General Internal Medicine / Issue 4/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05594-3

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