Understanding the impact of medical homes on the health care utilization and expenditures of chronically ill adults.

摘要

Growing challenges to health system quality and ongoing financial constraints warrant a paradigm shift in the organization and delivery of the health care system. There are both state and national level debates for the establishment of a Patient-Centered Medical Home (PCMH) as the centerpiece of primary care reform. While most states and the Centers for Medicare and Medicaid Services (CMS) have implemented demonstrations to test this model of care, to date limited empirical evidence is available.;The care provided in a PCMH is characterized as accessible, family centered, coordinated, continuous, culturally competent, and compassionate. This research seeks to estimate the impact of PCMH on two specific aspects of care: utilization and expenditures, as they are observed among adults who are chronically ill.;This is a cross-sectional study design that identifies a sub-population, chronically ill adults (18 years), participating in the Medical Expenditure Panel Survey (2004-2007) and living with asthma, diabetes, chronic obstructive pulmonary disease, high blood pressure, depression, arthritis, coronary heart disease, and stroke. To ascertain the construct of a PCMH, an exploratory factor analysis was conducted on twenty theoretically based items that might be considered part of a PCMH. Multiple regression models were conducted to assess the association between the degree of medical homeness and the health care outcomes of interest among 3,125 chronically ill adults.;Principle Component Analysis was used to extract a sixteen-item measure of two final factors. The American Academy of Pediatrics attributes observed in the two factors were quality and safety-focused care; coordinated care; comprehensive care and enhanced access with an overall Cronbach alpha = 0.64. Medical homeness was not significantly associated with total health care expenditures, prescription drugs, physician visits, ER visits and hospital discharges. Individuals in medical homes had significantly longer hospital stays than their non-medical home counterparts.;These findings add to the discussions concerning which features accurately measure a medical home. Further, it contributes to the ongoing debate about health care reform and the role of medical homes, as well as the relatively scarce body of research on measuring medical homes by levels rather than by a dichotomous variable.