141st APHA Annual Meeting

In This section

285930
Role of medical home in care delivery for those with chronic conditions

Monday, November 4, 2013 : 4:30 PM - 4:45 PM

Nadereh Pourat, PhD , Department of Health Services, UCLA School of Public Health/UCLA Center for Health Policy Research, Los Angeles, CA
Background: Emerging evidence supports the effectiveness of patient-centered medical home (PCMH) as a potential means of improving the health of populations with chronic conditions and reducing the costs of care. Objective: The Affordable Care Act (ACA) promotes PCMH. ACA's success partly depends on broad implementation of PCMH. PCMH is a promising approach to care and includes receipt of care from a personal doctor, who coordinates the patient's care, and develops an individualized treatment plan among other criteria. Yet, baseline population data on prevalence of these fundamental PCMH criteria are sparse. This study examines the availability of these three fundamental PCMH criteria in the general population with asthma, diabetes, and heart disease and identifies the starting point for PCMH implementation efforts. Methods: We used the 2009 California Health Interview Survey (CHIS)) and modeled doctor and emergency room visits, flu shots, timely communication with the provider, and confidence in managing one's chronic condition given availability of one or more PCMH criteria. We controlled for demographics, income, insurance, and health status in these logistic regression models. The adult population ages 18 and older who reported having asthma, diabetes, and heart disease (N=10,990) were selected for this study. Results: The data showed that uninsured, Medi-Cal beneficiaries, those at or below 133% of the FPL, Latinos, and Asian Americans less often reported all three PCMH criteria studied. Respondent with all three PCMH criteria were more likely than those without to report at least one doctor visit, no emergency room visits, and a flu shot in the past year. These respondents were also more likely to have received a return call from their providers always or usually. However, these respondents reported similar odds of 5 or more doctor visits (vs. 1-4) and the same confidence in their ability to manage their chronic condition than those without PCMH. Conclusions: The findings revealed that having access to three fundamental aspects of a PCMH may improve the care of those with chronic conditions. These individuals are more likely to receive primary and preventive care and avoid emergency room visits. The findings highlighted the population groups who would most benefit from interventions that increase receipt of care concordant with PMCH, particularly Medicaid beneficiaries and those eligible for the Health Benefit Exchanges. In addition, the potential for lower health care expenditures for those with chronic conditions with the receipt of more preventive care and less emergency room care exists.

Learning Areas:
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research

Learning Objectives:
Analyze the availability of three fundamental patient-centered medical home criteria in the general population with asthma, diabetes, and heart disease. Identify the starting point for patient-centered medical home implementation efforts.

Keywords: Health Reform, Medical Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the director of research at the UCLA Center for Health Policy Research. I also am a professor of health policy and management at the UCLA Fielding School of Public Health and a member of UCLA/Jonsson Comprehensive Cancer Cente. My research focuses on assessing disparities in access to care of underserved populations. I have examined the availability of employment-based insurance, access to care of injured workers, and access to STD care of publicly insured.
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.