Skip to main content

Advertisement

Log in

The Impact of the Patient-Centered Medical Home on Asthma-Related Visits to the Emergency Room: A Fixed Effects Regression Approach

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objective To estimate the effect of a patient-centered medical home (PCMH) intervention on asthma-related emergency room (ER) visits of pediatric patients. Methods Patients receiving care at pediatric primary care practices participating in the Florida Pediatric Medical Home Demonstration Project as well as pediatric patients treated at non-participating clinics were identified from 4 years of claims and enrollment data. We estimate several fixed effects logistic regression models using one pre-treatment year and three post-treatment years to investigate whether asthma-related ER visits decreased because of the PCMH intervention. Results The estimation suggests that the intervention did have a negative effect on asthma-related ER visits in the earlier part of the intervention (OR 0.34; 95% CI 0.16–0.73). However, this effect was not detected in the later years. Because fixed effects models require repeated observations on the same individual, we believe our estimations of the PCMH model’s impact is more accurate than previous studies. Conclusion for Practice Reducing asthma ER visits is a task that might be immediately actionable for PCMH practices, or those undergoing transformation. Our results adds to the others suggesting positive impacts of the PCMH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. For recent surveys of the literature, see Jackson et al. (2013), Hoff et al. (2012) and Peikes et al. (2012).

  2. For a detailed account of the Florida Pediatric Medical Home Demonstration Project, see Knapp et al. (2012).

References

  • American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2002). Policy statement: The medical home. Pediatrics, 110(1), 184–186.

    Article  Google Scholar 

  • Cassidy, A. (2010). Patient-centered medical homes. Health Policy Briefs. Health Affairs. Accessed August 11, 2014, from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=25.

  • Center of Medicaid and CHIP Services and CMS. (2013). Core set of children’s health care quality measures for Medicaid and CHIP. Washington, DC: Centers for Medicare and Medicaid Services.

    Google Scholar 

  • Crabtree, B. F., Nutting, P. A., Miller, W. L., Strange, K. C., Stewart, E. E., & Jaen, C. R. (2010). Summary of the National Demonstration Project for patient-centered medical home. Annals of Family Medicine, 8(Supplement 1), 80–89.

    Article  Google Scholar 

  • David, G., Gunnarsson, C., Saynisch, P. A., Chawla, R., & Nigam, S. (2015). Do patient-centered medical homes reduce emergency department visits? Health Services Research, 50(2), 418–439.

    Article  PubMed  Google Scholar 

  • Fifield, J., Forrest, D. D., Burleson, J. A., Martin-Peele, M., & Gillespie, W. (2013). Quality and efficiency in small practices transitioning to patient-centered medical home: A randomized trial. Journal of General Internal Medicine, 28(6), 778–786.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freidberg, M. W., Schneider, E. C., Rosenthal, M. B., Volpp, K. G., & Werner, R. M. (2014). Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. Journal of the American Medical Association, 311(8), 815–825.

    Article  CAS  Google Scholar 

  • Hoff, T., Weller, W., & DePuccio, M. (2012). The patient-centered medical home: A review of recent research. Medical Care Research and Review, 69(6), 619–644.

    Article  PubMed  Google Scholar 

  • Jackson, G. L., Powers, B. J., Chatterjee, R., Bettger, J. P., Kemper, A. R., Hasselbald, V., Dolor, R. J., Irvine, R. J., Heldenfelder, B. L., Kendrick, A. S., Gray, R., & Williams Jr, J. W. (2013). The patient-centered medical home: A systematic review. Annals of Internal Medicine, 158(3), 169–178.

    Article  PubMed  Google Scholar 

  • Knapp, C., Baker, K., Ranka, D., Sun, Y., Wei, L., & Xu, H. (2013). Pediatric performance measurement in Florida’s Children’s Health Insurance Program Reauthorization act demonstration grant. Gainesville, FL: Institute for Child Health Policy, University of Florida.

    Google Scholar 

  • Knapp, C., Madden, V., Baron-Lee., J., Ranka, D., Sun, Y., & Xu, H. (2012). Florida Pediatric Medical Home Demonstration Project Evaluation 2011. Gainesville, FL: Institute for Child Health Policy, University of Florida.

    Google Scholar 

  • Peikes, D., Zutshi, A., Genevro, J. L., Parchman, M. L., & Meyers, D. S. (2012). Early evaluations of the medical home: Building on a promising start. The American Journal of Managed Care, 18(2), 105–116.

    PubMed  Google Scholar 

  • Rosenthal, M. B., Friedberg, M. W., Singer, S. J., Eastman, D., Li, Z., & Schneider, E. C. (2013). Effect of a multipayer patient-centered medical home on health care utilization and quality: The Rhode Island chronic care sustainability initiative pilot program. JAMA Internal Medicine, 173(20), 1907–1913.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This document was developed under Grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shourjo Chakravorty.

Ethics declarations

Conflict of interest

Shourjo Chakravorty and Caprice A. Knapp declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chakravorty, S., Knapp, C.A. The Impact of the Patient-Centered Medical Home on Asthma-Related Visits to the Emergency Room: A Fixed Effects Regression Approach. Matern Child Health J 23, 369–376 (2019). https://doi.org/10.1007/s10995-018-2661-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-018-2661-4

Keywords

Navigation