312567
Association between primary care provider medical home characteristics and emergency department visits and hospitalizations among Medicaid patients
Methods: Cross-sectional study of 13,439 Medicaid enrollees from 39 safety net clinics in Colorado, Idaho, Massachusetts, and Oregon in 2009. Data were obtained from the Medicaid Analytic Extract files from each state. Medicaid enrollees were assigned to a clinic if they had at least 2 visits with that clinic and at least half of their primary care visits were with that clinic. Our key independent variable was a rating of PCMH characteristics of the safety net clinics based on a survey of clinic directors. The possible score ranged from 0 to 100. Our dependent variables were the number of ED visits, ambulatory care sensitive (ACS) ED visits, hospitalizations, and ACS hospitalizations for each patient. We created negative binomial models to assess the associations between each type of utilization and PCMH score, adjusting for covariates such as state where the clinic is located, patient characteristics, and neighborhood characteristics. We interpret the results in terms of the impact of a 10-point higher PCMH score on utilization.
Results: Mean PCMH score was 58.7 (standard deviation 12.5). 38.4% of patients had an ED visit, 31.7% had an ACS ED visit, 3.0% had a hospitalization, and 0.3% had an ACS hospitalization. A 10-point higher PCMH score was associated with 10% fewer hospitalizations (CI -0.2%-19%); this finding was of borderline statistical significance (p=0.055). PCMH score was not associated with the rate of ED visit, ACS ED visit or ACS hospitalizations.
Discussion: In our cross-sectional assessment, there was a trend toward higher clinic PCMH scores being associated with fewer hospitalizations among Medicaid enrollees who sought care in safety net clinics. Longitudinal studies should further investigate the relationship between these important utilization outcomes and improved PCMH characteristics in the safety net.
Learning Areas:
Administration, management, leadershipChronic disease management and prevention
Learning Objectives:
Describe how medical home characteristics are associated with ED utilization and hospitalization among Medicaid enrollees who sought care from safety net clinics
Keyword(s): Patient-Centered Care, Medicaid
Qualified on the content I am responsible for because: I am a health services researcher with experience analyzing claims data and studying the cost and organization of primary care in the safety net. Prior to my current academic role, I worked for seven years as a health care management consultant and gained experience with a broad range of health care cost analyses and use of a range of claims-based datasets.
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.