Effects of observed variations in primary care practice on Medicare patients' hospital utilization
Hospitalization is a sentinel event for older adults. Emerging evidence indicates that health system changes emphasizing patient-centered care, such as the patient-centered medical home (PCMH), can reduce hospitalizations; however, our previous system-wide analysis failed to detect a significant longitudinal change in hospitalizations. Empirical observations indicate that providers vary in how they apply patient-centered practices. Therefore, we assess the impact of Care by Design (CBD), the University of Utah Community Clinics' (UUCC) PCMH, on hospitalizations at the level of primary care practice cluster (grouping providers who practice similarly). First, ANOVA explored the relationship between a provider's clinic/team and their CBD implementation (30 elements categorized into one of three components: Appropriate Access (AA) , Care Teams (CT), and Planned Care (PC); 0=not implemented and 4=fully implemented; data collected in 2011). Statistically significant variation exists in AA, CT, and PC across UUCC clinics (p-value<0.000, <0.000, =0.038 respectively) and provider teams (p-value=0.024, <0.000, =0.009 respectively). Second, primary care practice clusters were formed using k-means cluster analysis on providers' CBD implementation. ANOVA assessed cluster quality. 6 distinct provider clusters were formed (all dimensions' p-values<0.000). Third, ANOVA is performed to assess the impact of each cluster on hospitalizations (2011 CMS Medicare data), controlling for patient demographics. We hypothesize that Medicare patients will experience different levels of hospitalization based on their provider's primary care cluster (analysis in process). This poster presents hospital utilization and analysis of variance for primary care clusters, within the UUCC system, ranging in PCMH implementation.
Administration, management, leadership
Chronic disease management and prevention
Provision of health care to the public
Define the complex system redesign that is the patient centered medical home (PCMH).
Differentiate among providers practicing within the same health care delivery system, even within the same clinic and team.
Assess the impact of differential primary care operationalization on hospital utilization.
Keyword(s): Primary Care, Health Care Utilization
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am a Public Health PhD candidate at the London School of Hygiene and Tropical Medicine presenting dissertation results. My committee consists of experts in systems thinking, system dynamics, statistics, primary care, and health systems as well as medical doctors and administrators within the system that I am studying. This work is funded by grants from AHRQ as well as HHS (see external funding section above) â I am a Research Associate on these grants.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.