Chronic care management improves as VA clinics implement patient-centered medical homes

Team of doctors talking
Implementing elements of a patient-centered medical home model in Veterans Health Affairs clinics led to better chronic disease management.

The more primary care clinics implemented components of a patient-centered medical home model, the greater they were able to improve their management of chronic diseases, a new study found.

The study, published in Health Services Research, reviewed data from more than 800 Veterans Health Administration (VHA) primary care clinics and revealed that national implementation of a patient-centered medical home (PCMH) model improved several chronic disease outcomes over time.

Clinics with the most medical home components in place in 2012 had greater improvements in several chronic disease quality measures than those with the lowest number, the study found.

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The VHA put in place its Patient Aligned Care Teams (PACT) initiative in 2010, the largest program in the country to implement PCMH care. The VHA assigned the 5 million primary care patients in the network to a team designed to provide multidisciplinary healthcare support focused on their needs.

All the clinics had access to the same resources, tools and training to implement the model, which focuses on eight areas of care, including access, continuity, coordination, team-based care, comprehensiveness of care, self-management support, patient-centered communication and shared decision-making.

Over the course of four years, researchers analyzed medical records from the participating clinics to measure 15 clinical outcomes and processes to determine how the model influenced care with patients with three common and costly chronic diseases—coronary artery disease, diabetes and hypertension.

Researchers found the 77 clinics that had most fully executed the PACT model by 2012 had significantly larger improvement in five of the seven chronic disease outcome measures and two of the eight clinical process measures compared to the 69 clinics that had implemented the fewest elements of the model. In the clinics with the most advanced implementation, 1% to 5% more of patients met established levels for diabetes, blood pressure and cholesterol control.

“While not every clinical measure improved as significantly as others with increased implementation of the PACT model, this study demonstrates that health systems that invest in changes in care delivery through a medical home model for all primary care patients could see downstream improvements in the management of those patients with chronic diseases,” said lead researcher Ann-Marie Rosland, M.D., associate professor of internal medicine at the University of Pittsburgh School of Medicine, in an announcement.

While most studies of medical home models have looked at whether doctors and nurses are following recommended processes, such as checking patients’ blood sugar levels during visits, this study was able to assess the impact on the control of chronic conditions, such as whether patients brought sugar levels down to recommended goals, said Rosland, who holds a position at the VA Pittsburgh Center for health Equity Research and Promotion.

Reviews of PCMHs suggest that they lead to lower costs and improved care quality, but a significant investment in primary care and strong payer-provider collaboration is key to success.

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