Estimating Associations Between Medical Home Adoption, Utilization, and Quality

A Comparison of Evaluation Approaches

Published in: Medical Care, Volume 56, Number 1 (January 2018), pages 25-30. doi: 10.1097/MLR.0000000000000842

Posted on RAND.org on January 25, 2018

by Grant R. Martsolf, Ryan Kandrack, Matthew D. Baird, Mark W. Friedberg

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Background

Methodological differences between evaluations of medical home adoption might complicate readers' ability to draw conclusions across studies.

Objectives

To study whether associations between medical home adoption and patient care are affected by methodological choices.

Design, Setting, and Subjects

Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of "medical home adoption" [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality.

Measurements

Six utilization and 6 quality measures.

Results

In cross-sectional analyses at year 3, NCQA recognition was associated with higher rates of nephropathy monitoring (7.23 percentage points; confidence interval, 0.45-14.02), breast cancer screening (7.48; 2.11-12.86), and colorectal cancer screening (8.43; 2.44-14.42). In longitudinal analyses, NCQA recognition was associated with increases in hospitalization rates (2.75 per 1000 patient-months; 0.52-4.98). In baseline cross-sectional analyses, higher Medical Home Index scores were associated with fewer ambulatory care-sensitive hospitalizations (-0.61 per 1000 patient per month; -1.11 to -0.11), all-cause emergency department visits (-6.80; -12.28 to -1.32), and ambulatory care-sensitive emergency department visits (-5.60; 10.32 to -0.88). There were no statistically significant associations between any other measure of medical home adoption and quality or utilization.

Conclusions

The findings of medical home evaluations are sensitive to methodological choices. Meta-analyses, narrative reviews, and other syntheses of medical home studies should consider subdividing their findings by analytic approach.

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