Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial
ABSTRACT BACKGROUND There is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the qu...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2013-06, Vol.28 (6), p.778-786 |
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| creator | Fifield, Judith Forrest, Deborah Dauser Burleson, Joseph A. Martin-Peele, Melanie Gillespie, William |
| description | ABSTRACT
BACKGROUND
There is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the quality and efficiency outcomes associated with this transition.
OBJECTIVE
Test quality and efficiency outcomes associated with 2-year transition to PCMH status among physicians in intervention versus control practices.
DESIGN
Randomized Controlled Trial.
PARTICIPANTS
Eighteen intervention practices with 43 physicians and 14 control practices with 24 physicians; all from adult primary care practices.
INTERVENTIONS
Modeled on 2008 NCQA PPC®-PCMH™, intervention practices received 18 months of tailored practice redesign support; 2 years of revised payment, including up to $2.50 per member per month (PMPM) for achieving quality targets and up to $2.50 PMPM for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.
MAIN MEASURES
Eleven clinical quality indicators from the 2009 HEDIS process and health outcomes measures derived from patient claims data; Ten efficiency indicators based on Thomson Reuter efficiency indexes and Emergency Department (ED) Visit Ratios; and a panel of costs of care measures.
KEY RESULTS
Compared to control physicians, intervention physicians significantly improved TWO of 11 quality indicators: hypertensive blood pressure control over 2 years (intervention +23 percentage points, control –2 percentage points,
p
= 0.02) and breast cancer screening over 3 years (intervention +3.5 percentage points, control −0.4 percentage points,
p
= 0.03). Compared to control physicians, intervention physicians significantly improved ONE of ten efficiency indicators: number of care episodes resulting in ED visits was reduced (intervention −0.7 percentage points, control + 0.5 percentage points,
p
= 0.002), with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant cost-savings on any of the pre-specified costs of care measures.
CONCLUSIONS
In a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over 2 years, although most indicators did not improve and there were no cost-savings com |
| doi_str_mv | 10.1007/s11606-013-2386-4 |
| format | Article |
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BACKGROUND
There is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the quality and efficiency outcomes associated with this transition.
OBJECTIVE
Test quality and efficiency outcomes associated with 2-year transition to PCMH status among physicians in intervention versus control practices.
DESIGN
Randomized Controlled Trial.
PARTICIPANTS
Eighteen intervention practices with 43 physicians and 14 control practices with 24 physicians; all from adult primary care practices.
INTERVENTIONS
Modeled on 2008 NCQA PPC®-PCMH™, intervention practices received 18 months of tailored practice redesign support; 2 years of revised payment, including up to $2.50 per member per month (PMPM) for achieving quality targets and up to $2.50 PMPM for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.
MAIN MEASURES
Eleven clinical quality indicators from the 2009 HEDIS process and health outcomes measures derived from patient claims data; Ten efficiency indicators based on Thomson Reuter efficiency indexes and Emergency Department (ED) Visit Ratios; and a panel of costs of care measures.
KEY RESULTS
Compared to control physicians, intervention physicians significantly improved TWO of 11 quality indicators: hypertensive blood pressure control over 2 years (intervention +23 percentage points, control –2 percentage points,
p
= 0.02) and breast cancer screening over 3 years (intervention +3.5 percentage points, control −0.4 percentage points,
p
= 0.03). Compared to control physicians, intervention physicians significantly improved ONE of ten efficiency indicators: number of care episodes resulting in ED visits was reduced (intervention −0.7 percentage points, control + 0.5 percentage points,
p
= 0.002), with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant cost-savings on any of the pre-specified costs of care measures.
CONCLUSIONS
In a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over 2 years, although most indicators did not improve and there were no cost-savings compared with control practices. For the most part, quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-013-2386-4</identifier><identifier>PMID: 23456697</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Clinical trials ; Efficiency, Organizational ; Female ; General aspects ; Health Care Reform ; Humans ; Internal Medicine ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Organizational Innovation ; Original Research ; Outcome and Process Assessment (Health Care) - methods ; Patient-Centered Care - organization & administration ; Patient-Centered Care - standards ; Patients ; Primary Health Care - organization & administration ; Primary Health Care - standards ; Quality Assurance, Health Care - methods ; Quality of care ; Quality of Health Care ; United States</subject><ispartof>Journal of general internal medicine : JGIM, 2013-06, Vol.28 (6), p.778-786</ispartof><rights>Society of General Internal Medicine 2013</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c500t-9b0759863228bd294e31721b34144e143e01908e94ebff58e130dffb9a9079e23</citedby><cites>FETCH-LOGICAL-c500t-9b0759863228bd294e31721b34144e143e01908e94ebff58e130dffb9a9079e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663935/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663935/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27925,27926,41489,42558,51320,53792,53794</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27711991$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23456697$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fifield, Judith</creatorcontrib><creatorcontrib>Forrest, Deborah Dauser</creatorcontrib><creatorcontrib>Burleson, Joseph A.</creatorcontrib><creatorcontrib>Martin-Peele, Melanie</creatorcontrib><creatorcontrib>Gillespie, William</creatorcontrib><title>Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>ABSTRACT
BACKGROUND
There is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the quality and efficiency outcomes associated with this transition.
OBJECTIVE
Test quality and efficiency outcomes associated with 2-year transition to PCMH status among physicians in intervention versus control practices.
DESIGN
Randomized Controlled Trial.
PARTICIPANTS
Eighteen intervention practices with 43 physicians and 14 control practices with 24 physicians; all from adult primary care practices.
INTERVENTIONS
Modeled on 2008 NCQA PPC®-PCMH™, intervention practices received 18 months of tailored practice redesign support; 2 years of revised payment, including up to $2.50 per member per month (PMPM) for achieving quality targets and up to $2.50 PMPM for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.
MAIN MEASURES
Eleven clinical quality indicators from the 2009 HEDIS process and health outcomes measures derived from patient claims data; Ten efficiency indicators based on Thomson Reuter efficiency indexes and Emergency Department (ED) Visit Ratios; and a panel of costs of care measures.
KEY RESULTS
Compared to control physicians, intervention physicians significantly improved TWO of 11 quality indicators: hypertensive blood pressure control over 2 years (intervention +23 percentage points, control –2 percentage points,
p
= 0.02) and breast cancer screening over 3 years (intervention +3.5 percentage points, control −0.4 percentage points,
p
= 0.03). Compared to control physicians, intervention physicians significantly improved ONE of ten efficiency indicators: number of care episodes resulting in ED visits was reduced (intervention −0.7 percentage points, control + 0.5 percentage points,
p
= 0.002), with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant cost-savings on any of the pre-specified costs of care measures.
CONCLUSIONS
In a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over 2 years, although most indicators did not improve and there were no cost-savings compared with control practices. For the most part, quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clinical trials</subject><subject>Efficiency, Organizational</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Care Reform</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Organizational Innovation</subject><subject>Original Research</subject><subject>Outcome and Process Assessment (Health Care) - methods</subject><subject>Patient-Centered Care - organization & administration</subject><subject>Patient-Centered Care - standards</subject><subject>Patients</subject><subject>Primary Health Care - organization & administration</subject><subject>Primary Health Care - standards</subject><subject>Quality Assurance, Health Care - methods</subject><subject>Quality of care</subject><subject>Quality of Health Care</subject><subject>United States</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV9rFDEUxYModlv9AL5IQARfRnMnmT_xQShLtULFqutzyGTurCkzSZvMCttP7112rVXwJXk4v3tybg5jz0C8BiGaNxmgFnUhQBalbOtCPWALqMqqAKWbh2wh2lYVbSPVETvO-UoQWJbtY3ZUSlXVtW4WbPqysaOft9yGnp8Ng3ceg9tyH_i3yY4jv0zWzd5h5qtkQ_azj8GHNZ8jv7QzwTNf0oEJe_4Je-_syM_jhPktP-VfyTVO_pa0VfJ2fMIeDXbM-PRwn7Dv789Wy_Pi4vOHj8vTi8JVQsyF7kRT6bbepe36UiuU0JTQSQVKISiJArRokYRuGKoWQYp-GDpttWg0lvKEvdv7Xm-6CXtHAZMdzXXyk01bE603fyvB_zDr-NPIupZaVmTw6mCQ4s0G82wmnx2Oow0YN9mArAgEISWhL_5Br-ImBVpvR1EbglYhCvaUSzHnhMNdGBBmV6bZl2moI7Mr0yiaeX5_i7uJ3-0R8PIA2Ez_PlBBzuc_XNMAaA3ElXsukxTWmO5F_O_rvwCvxrae</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Fifield, Judith</creator><creator>Forrest, Deborah Dauser</creator><creator>Burleson, Joseph A.</creator><creator>Martin-Peele, Melanie</creator><creator>Gillespie, William</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130601</creationdate><title>Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial</title><author>Fifield, Judith ; Forrest, Deborah Dauser ; Burleson, Joseph A. ; Martin-Peele, Melanie ; Gillespie, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c500t-9b0759863228bd294e31721b34144e143e01908e94ebff58e130dffb9a9079e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Clinical trials</topic><topic>Efficiency, Organizational</topic><topic>Female</topic><topic>General aspects</topic><topic>Health Care Reform</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Organizational Innovation</topic><topic>Original Research</topic><topic>Outcome and Process Assessment (Health Care) - methods</topic><topic>Patient-Centered Care - organization & administration</topic><topic>Patient-Centered Care - standards</topic><topic>Patients</topic><topic>Primary Health Care - organization & administration</topic><topic>Primary Health Care - standards</topic><topic>Quality Assurance, Health Care - methods</topic><topic>Quality of care</topic><topic>Quality of Health Care</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fifield, Judith</creatorcontrib><creatorcontrib>Forrest, Deborah Dauser</creatorcontrib><creatorcontrib>Burleson, Joseph A.</creatorcontrib><creatorcontrib>Martin-Peele, Melanie</creatorcontrib><creatorcontrib>Gillespie, William</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fifield, Judith</au><au>Forrest, Deborah Dauser</au><au>Burleson, Joseph A.</au><au>Martin-Peele, Melanie</au><au>Gillespie, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>28</volume><issue>6</issue><spage>778</spage><epage>786</epage><pages>778-786</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>ABSTRACT
BACKGROUND
There is growing evidence that even small and solo primary care practices can successfully transition to full Patient Centered Medical Home (PCMH) status when provided with support, including practice redesign, care managers, and a revised payment plan. Less is known about the quality and efficiency outcomes associated with this transition.
OBJECTIVE
Test quality and efficiency outcomes associated with 2-year transition to PCMH status among physicians in intervention versus control practices.
DESIGN
Randomized Controlled Trial.
PARTICIPANTS
Eighteen intervention practices with 43 physicians and 14 control practices with 24 physicians; all from adult primary care practices.
INTERVENTIONS
Modeled on 2008 NCQA PPC®-PCMH™, intervention practices received 18 months of tailored practice redesign support; 2 years of revised payment, including up to $2.50 per member per month (PMPM) for achieving quality targets and up to $2.50 PMPM for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.
MAIN MEASURES
Eleven clinical quality indicators from the 2009 HEDIS process and health outcomes measures derived from patient claims data; Ten efficiency indicators based on Thomson Reuter efficiency indexes and Emergency Department (ED) Visit Ratios; and a panel of costs of care measures.
KEY RESULTS
Compared to control physicians, intervention physicians significantly improved TWO of 11 quality indicators: hypertensive blood pressure control over 2 years (intervention +23 percentage points, control –2 percentage points,
p
= 0.02) and breast cancer screening over 3 years (intervention +3.5 percentage points, control −0.4 percentage points,
p
= 0.03). Compared to control physicians, intervention physicians significantly improved ONE of ten efficiency indicators: number of care episodes resulting in ED visits was reduced (intervention −0.7 percentage points, control + 0.5 percentage points,
p
= 0.002), with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant cost-savings on any of the pre-specified costs of care measures.
CONCLUSIONS
In a randomized trial, we observed that some indicators of quality and efficiency of care in general adult primary care practices transitioning to PCMH status can be significantly, but modestly, improved over 2 years, although most indicators did not improve and there were no cost-savings compared with control practices. For the most part, quality and efficiency of care provided in unsupported control practices remained unchanged or worsened during the trial.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23456697</pmid><doi>10.1007/s11606-013-2386-4</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2013-06, Vol.28 (6), p.778-786 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3663935 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Biological and medical sciences Clinical trials Efficiency, Organizational Female General aspects Health Care Reform Humans Internal Medicine Male Medical sciences Medicine Medicine & Public Health Middle Aged Organizational Innovation Original Research Outcome and Process Assessment (Health Care) - methods Patient-Centered Care - organization & administration Patient-Centered Care - standards Patients Primary Health Care - organization & administration Primary Health Care - standards Quality Assurance, Health Care - methods Quality of care Quality of Health Care United States |
| title | Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial |
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