Improving patient center medical home coordination in a safety net healthcare system among adults living with HIV

Background: While new care models, such as patient-centered medical homes (PCMH), are continuing to see increased adoption, Ryan White CARE Act-funded clinics have already been practicing such models for over a decade. This present study aims to examine the characteristics and PCMH case management utilization patterns in a safety net healthcare system of adults living with HIV. We hypothesize that social factors will be associated with case management utilization even after accounting for medical complexity.

Methods: Data were drawn from two sources: the electronic medical record and a social services database for 610 HIV-positive patients who received case management services during the measurement period (2008 - 2010). We measured case management utilization per month (minutes), medical complexity (adapted from the Johns Hopkins' ACG tool), and self-report demographic and socioeconomic variables (e.g., education, housing status). Adjusted linear regression models were used to test our study hypothesis.

Results: On average, patients received 141 minutes of case management services per month (range: 2-910 minutes/month). Medical complexity modestly predicted care coordination utilization. However, other Social and behavior variables provided a greater contribution to case management utilization, including: housing status (β=75.5; p < 0.0001), literacy (β=43.2; p < 0.05), and interpreter requirements (β=59.5; p < 0.0001).

Conclusions: Our findings suggest that future care models may need to incorporate social factors such as housing status, literacy and socioeconomic status. Future risk stratification tools may be further refined to impact care coordination for patients with HIV.