The relationships between access to and use of a patient-centered medical home and healthcare utilization and costs

A cohort study using Medical Expenditure Panel Survey data from 2007 to 2010

Haichang Xin, Meredith L. Kilgore, Nir Menachemi, Bisakha (Pia) Sen

Research output: Contribution to journalArticle

Abstract

Objective: The patient-centered medical home has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality while reducing costs. This study is among the first to examine how patient perceived patient-centered medical home is related to utilization and costs for emergency department and inpatient care nationwide in the U.S. Methods: This retrospective cohort study used data from the 2007–2010 Medical Expenditure Panel Survey. This study focused upon insured individuals aged 18 and older. In each two-year cohort, we measured and identified a full patient-centered medical home group, a partial patient-centered medical home group (with a usual source of care but not a patient-centered medical home), and an unknown patient-centered medical home group. Using negative binomial regression and generalized linear models, we conducted the analysis while controlling for covariates at baseline. Given the nature of the complex survey design, we adjusted weights and variance. Results: The study sample consisted of 15,595 individuals, representing a total of 368 million people in the U.S. In the trend of outcome changes from the baseline to the follow-up year, the full and partial patient-centered medical home groups demonstrated reduced efficiency for the 2007–2008 cohort, but increased efficiency for the 2009–2010 cohort, as compared to the no regular provider group. Conclusions: Overall, the empirical evidence does not indicate whether patient-centered medical home models reduce healthcare utilization and costs, but it does suggest their potential as mechanisms for achieving healthcare system efficiency, when primary care practices have grown from early to middle stage of patient-centered medical home transformation. A longer observation window and holistic view on all stages of patient-centered medical home growth may be more informative on patient-centered medical home’s efficiency.

Original languageEnglish (US)
Pages (from-to)70-81
Number of pages12
JournalHealth Services Management Research
Volume27
Issue number3-4
DOIs
StatePublished - Aug 1 2014
Externally publishedYes

Fingerprint

Patient-Centered Care
Health Expenditures
Health Care Costs
Cohort Studies
Surveys and Questionnaires
Delivery of Health Care
Costs and Cost Analysis
Quality of Health Care
Hospital Emergency Service
Inpatients
Linear Models
Primary Health Care
Retrospective Studies

Keywords

  • Emergency department and inpatient care
  • health system efficiency
  • nationwide
  • patient-centered medical home
  • patients’ experience
  • utilization and costs

ASJC Scopus subject areas

  • Health Policy

Cite this

@article{cd7ae1963f334af0a2231a7839c6a94d,
title = "The relationships between access to and use of a patient-centered medical home and healthcare utilization and costs: A cohort study using Medical Expenditure Panel Survey data from 2007 to 2010",
abstract = "Objective: The patient-centered medical home has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality while reducing costs. This study is among the first to examine how patient perceived patient-centered medical home is related to utilization and costs for emergency department and inpatient care nationwide in the U.S. Methods: This retrospective cohort study used data from the 2007–2010 Medical Expenditure Panel Survey. This study focused upon insured individuals aged 18 and older. In each two-year cohort, we measured and identified a full patient-centered medical home group, a partial patient-centered medical home group (with a usual source of care but not a patient-centered medical home), and an unknown patient-centered medical home group. Using negative binomial regression and generalized linear models, we conducted the analysis while controlling for covariates at baseline. Given the nature of the complex survey design, we adjusted weights and variance. Results: The study sample consisted of 15,595 individuals, representing a total of 368 million people in the U.S. In the trend of outcome changes from the baseline to the follow-up year, the full and partial patient-centered medical home groups demonstrated reduced efficiency for the 2007–2008 cohort, but increased efficiency for the 2009–2010 cohort, as compared to the no regular provider group. Conclusions: Overall, the empirical evidence does not indicate whether patient-centered medical home models reduce healthcare utilization and costs, but it does suggest their potential as mechanisms for achieving healthcare system efficiency, when primary care practices have grown from early to middle stage of patient-centered medical home transformation. A longer observation window and holistic view on all stages of patient-centered medical home growth may be more informative on patient-centered medical home’s efficiency.",
keywords = "Emergency department and inpatient care, health system efficiency, nationwide, patient-centered medical home, patients’ experience, utilization and costs",
author = "Haichang Xin and Kilgore, {Meredith L.} and Nir Menachemi and Sen, {Bisakha (Pia)}",
year = "2014",
month = "8",
day = "1",
doi = "10.1177/0951484815602503",
language = "English (US)",
volume = "27",
pages = "70--81",
journal = "Health Services Management Research",
issn = "0951-4848",
publisher = "SAGE Publications Ltd",
number = "3-4",

}

TY - JOUR

T1 - The relationships between access to and use of a patient-centered medical home and healthcare utilization and costs

T2 - A cohort study using Medical Expenditure Panel Survey data from 2007 to 2010

AU - Xin, Haichang

AU - Kilgore, Meredith L.

AU - Menachemi, Nir

AU - Sen, Bisakha (Pia)

PY - 2014/8/1

Y1 - 2014/8/1

N2 - Objective: The patient-centered medical home has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality while reducing costs. This study is among the first to examine how patient perceived patient-centered medical home is related to utilization and costs for emergency department and inpatient care nationwide in the U.S. Methods: This retrospective cohort study used data from the 2007–2010 Medical Expenditure Panel Survey. This study focused upon insured individuals aged 18 and older. In each two-year cohort, we measured and identified a full patient-centered medical home group, a partial patient-centered medical home group (with a usual source of care but not a patient-centered medical home), and an unknown patient-centered medical home group. Using negative binomial regression and generalized linear models, we conducted the analysis while controlling for covariates at baseline. Given the nature of the complex survey design, we adjusted weights and variance. Results: The study sample consisted of 15,595 individuals, representing a total of 368 million people in the U.S. In the trend of outcome changes from the baseline to the follow-up year, the full and partial patient-centered medical home groups demonstrated reduced efficiency for the 2007–2008 cohort, but increased efficiency for the 2009–2010 cohort, as compared to the no regular provider group. Conclusions: Overall, the empirical evidence does not indicate whether patient-centered medical home models reduce healthcare utilization and costs, but it does suggest their potential as mechanisms for achieving healthcare system efficiency, when primary care practices have grown from early to middle stage of patient-centered medical home transformation. A longer observation window and holistic view on all stages of patient-centered medical home growth may be more informative on patient-centered medical home’s efficiency.

AB - Objective: The patient-centered medical home has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality while reducing costs. This study is among the first to examine how patient perceived patient-centered medical home is related to utilization and costs for emergency department and inpatient care nationwide in the U.S. Methods: This retrospective cohort study used data from the 2007–2010 Medical Expenditure Panel Survey. This study focused upon insured individuals aged 18 and older. In each two-year cohort, we measured and identified a full patient-centered medical home group, a partial patient-centered medical home group (with a usual source of care but not a patient-centered medical home), and an unknown patient-centered medical home group. Using negative binomial regression and generalized linear models, we conducted the analysis while controlling for covariates at baseline. Given the nature of the complex survey design, we adjusted weights and variance. Results: The study sample consisted of 15,595 individuals, representing a total of 368 million people in the U.S. In the trend of outcome changes from the baseline to the follow-up year, the full and partial patient-centered medical home groups demonstrated reduced efficiency for the 2007–2008 cohort, but increased efficiency for the 2009–2010 cohort, as compared to the no regular provider group. Conclusions: Overall, the empirical evidence does not indicate whether patient-centered medical home models reduce healthcare utilization and costs, but it does suggest their potential as mechanisms for achieving healthcare system efficiency, when primary care practices have grown from early to middle stage of patient-centered medical home transformation. A longer observation window and holistic view on all stages of patient-centered medical home growth may be more informative on patient-centered medical home’s efficiency.

KW - Emergency department and inpatient care

KW - health system efficiency

KW - nationwide

KW - patient-centered medical home

KW - patients’ experience

KW - utilization and costs

UR - http://www.scopus.com/inward/record.url?scp=84955275844&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955275844&partnerID=8YFLogxK

U2 - 10.1177/0951484815602503

DO - 10.1177/0951484815602503

M3 - Article

VL - 27

SP - 70

EP - 81

JO - Health Services Management Research

JF - Health Services Management Research

SN - 0951-4848

IS - 3-4

ER -