Statewide Medical Home Pilot Reduces ED Visits

A patient-centered medical home pilot program in Rhode Island significantly improved medical home recognition scores in ambulatory ED visits, according to an article published in JAMA Internal Medicine.

The Rhode Island Chronic Care Sustainability Initiative (CSI) went into effect in 2008 with support from the three largest insurers in the state, which committed about $2 million for two years of support. Five primary care practices, including one federally qualified health center, with a total of 45 primary care physicians, volunteered for the pilot and applied for NCQA recognition.

Researchers from the Department of Health Policy and Management, Harvard School of Public Health, analyzed multi-payor claims data from two years before the pilot program and/or two years after the program began. Their reference for scoring was audit data from the NCQA patient-centered medical home recognition process. In addition to analyzing claims data, the researchers analyzed NCQA data on medical home structures and processes, and they interviewed practice leaders at baseline, after one year, and at the end of the study period.

The researchers used propensity scoring and binomial models, adjusting for a number of variables, including patient age, sex, and linear time trend. They compared data from the five intervention practices, with 31,130 member months per practice, with data from 34 comparison practices with 14,779 member months per practice.

Rhode Island CSI practices were required to track and share standard clinical quality indicators with each other and with participating payors, to maintain ongoing quality improvement, and to document activities in nine areas, including care management and referral tracking.

Key findings include the following data:

  • The CSI practices achieved overall scores of 88.0 to 92.0 out of a possible 100 in two years, up from 30.0 to 56.0 at baseline, and all achieved NCQA recognition.
  • The CSI practices reduced ambulatory ED visits by 11.6 percent (0.08/1000 member months; P = .002) from baseline (6.9/1000 member months).
  • Researchers found largely insignificant downward trends in overall ED visits and inpatient admissions. Primary care and specialist office visits were largely unchanged.
  • Regarding quality care measures of diabetes and cancer screening, there were no significant improvement, although there was a nonsignificant improvement in diabetes screening.

Source: The Commonwealth Fund , September 10, 2013

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New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care offers snapshots of thriving medical home initiatives and their particular area of focus.

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