The Impact of Comprehensive Pre-visit Preparation on Patient Engagement and Quality of Care in a Population of Underserved Patients with Diabetes: Evidence from the Care Management Medical Home Center Model

摘要

This study evaluated the impact of pre-visit preparation, a key component of Patient-Centered Medical Home guidelines, on compliance with recommended tests and screenings in a diabetic patient population receiving care in Federally Qualified Health Centers in Miami-Dade County. The pre-visit preparation consisted of a pre-visit phone call to review patient compliance with recommended tests and screenings, provide encouragement for self-care goal setting, answer patient questions, assure referrals and tests were scheduled, and notify an in-center patient care team about which services are required at the upcoming visit. Aggregated data from 7 health centers and a cohort analysis of 7491 patients showed significantly higher compliance among those who were successfully contacted prior to the visit compared to those who were not successfully contacted at 24 months for all compliance measures included in the study. These results included a 28.8 percentage point difference in compliance with HbA1c testing, a 14.6 percentage point difference in influenza immunization, a 27.7 percentage point difference in diabetic foot exam compliance, and a 33.2 percentage point difference in compliance with annual low-density lipoprotein testing. After 24 months, the patient no-show rate decreased by 6.8 percentage points (from 20.7% to 14.0%) among contacted patients and by 5.5 percentage points (from 20.7% to 15.2%) among patients who were not contacted. Study results suggest that proactive pre-visit preparation may be a key strategy for primary care practices to improve areas critical for chronic disease management, such as patient engagement, appointments kept, and compliance with recommended screenings, tests, and services. (Population Health Management 2016;19:171-177)