Study: Patient-centered medical home can better diabetic outcomes
The patient-centered medical home (PCMH) can increase the percentage of diabetes patients who achieve goals that reduce their sickness and mortality rates, according to study findings published in the June edition of the Joint Commission Journal on Quality and Patient Safety.
By the authors’ definition, PCMH incorporates a chronic-care model of care and provides coordinated primary care that is integrated across a healthcare system by a physician-led team.
"This arrangement … brings together multiple insurance payors convened by a state body without regulatory oversight to contract with a diverse range of practices across the state for broad-scale implementation of better care leveraged by payment reform,” said Robert A. Gabbay, MD, PhD, professor of medicine at Pennsylvania State College of Medicine and director of the Pennsylvania State Hershey Diabetes and Obesity Institute in Hershey, Pa. Gabbay added that this is one of the largest multi-payor PCMH programs in the U.S.
While studying the use of the PCMH in diabetic patients, the researchers implemented the model for diabetes patients in 25 practices in southeast Pennsylvania encompassing metropolitan Philadelphia.
"Diabetes is one of the most costly of chronic diseases, accounting for $174 billion in medical care each year in the U.S., with the cost of care for patients with diabetes averaging 2.3 times higher than similar patients without diabetes," Gabbay said. "Specifically for diabetes, only 7 percent of patients meet evidenced-based goals for the key predictors of morbidity and mortality: hemoglobin A1c, blood pressure and LDL cholesterol.
"This model makes physicians look at their patient population in general, not just the individual. The focus has always been on the individual,” noted Gabbay, adding that by examining the broad population, a physician can ask, for example: What percentage of my patients is getting a yearly eye exam, which could potentially prevent blindness?
“Most practices wouldn't know that. Without measuring it, you can't work to improve it. If a low number of patients are getting an eye exam, do you maybe send out a letter to patients who need one to improve that?" he asked.
In PCMH, care is coordinated on patients' needs. The researchers reported a significant improvement in adherence to evidenced-based care guidelines and in clinical outcomes. In one year, the number of patients with better LDL levels, better blood pressure and lower A1c levels increased. The number of patients receiving yearly foot exams, eye exams and pneumonia and influenza vaccines also increased.
Those patients older than 45 years who took statins to reduce potential cardiovascular problems from type 2 diabetes and those using ACE inhibitors or ARB agents to reduce cardiovascular disease risk increased. In addition, the provider reported a percentage of patients with established self-management goals increased to nearly 70 percent.
During the first intervention year, all practices achieved at least Level 1 National Committee for Quality Assurance Physician Practice Connections Patient-Centered Medical Home recognition, according to the study authors. Overall, the study found that there was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, ACE inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
By the authors’ definition, PCMH incorporates a chronic-care model of care and provides coordinated primary care that is integrated across a healthcare system by a physician-led team.
"This arrangement … brings together multiple insurance payors convened by a state body without regulatory oversight to contract with a diverse range of practices across the state for broad-scale implementation of better care leveraged by payment reform,” said Robert A. Gabbay, MD, PhD, professor of medicine at Pennsylvania State College of Medicine and director of the Pennsylvania State Hershey Diabetes and Obesity Institute in Hershey, Pa. Gabbay added that this is one of the largest multi-payor PCMH programs in the U.S.
While studying the use of the PCMH in diabetic patients, the researchers implemented the model for diabetes patients in 25 practices in southeast Pennsylvania encompassing metropolitan Philadelphia.
"Diabetes is one of the most costly of chronic diseases, accounting for $174 billion in medical care each year in the U.S., with the cost of care for patients with diabetes averaging 2.3 times higher than similar patients without diabetes," Gabbay said. "Specifically for diabetes, only 7 percent of patients meet evidenced-based goals for the key predictors of morbidity and mortality: hemoglobin A1c, blood pressure and LDL cholesterol.
"This model makes physicians look at their patient population in general, not just the individual. The focus has always been on the individual,” noted Gabbay, adding that by examining the broad population, a physician can ask, for example: What percentage of my patients is getting a yearly eye exam, which could potentially prevent blindness?
“Most practices wouldn't know that. Without measuring it, you can't work to improve it. If a low number of patients are getting an eye exam, do you maybe send out a letter to patients who need one to improve that?" he asked.
In PCMH, care is coordinated on patients' needs. The researchers reported a significant improvement in adherence to evidenced-based care guidelines and in clinical outcomes. In one year, the number of patients with better LDL levels, better blood pressure and lower A1c levels increased. The number of patients receiving yearly foot exams, eye exams and pneumonia and influenza vaccines also increased.
Those patients older than 45 years who took statins to reduce potential cardiovascular problems from type 2 diabetes and those using ACE inhibitors or ARB agents to reduce cardiovascular disease risk increased. In addition, the provider reported a percentage of patients with established self-management goals increased to nearly 70 percent.
During the first intervention year, all practices achieved at least Level 1 National Committee for Quality Assurance Physician Practice Connections Patient-Centered Medical Home recognition, according to the study authors. Overall, the study found that there was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, ACE inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.