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Patient-Centered Medical Home: How It Affects Psychosocial Outcomes for Diabetes

  • Psychosocial Aspects (K Hood, Section Editor)
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Abstract

Fragmentation of the current U.S. health care system and the increased prevalence of chronic diseases in the U.S. have led to the recognition that new models of care are needed. Chronic disease management, including diabetes, is often accompanied by a myriad of associated psychosocial issues that need to be addressed as part of a comprehensive treatment plan. Diabetes care should be aligned with comprehensive whole-person health care. The patient-centered medical home (PCMH) has emerged as a model for enhanced primary care that focuses on comprehensive integrated care. PCMH demonstration projects have shown improvements in quality of care, patient experience, care coordination, access to care, and quality measures for diabetes. Key PCMH transformative features associated with psychosocial issues related to diabetes reviewed in this article include integration of mental and behavioral health, care management/coordination, payment reform, advanced access, and putting the patient at the center of health care. This article also reviews the evidence supporting comprehensive and integrated care for addressing psychosocial issues associated with diabetes in the medical home.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  2. Goodson JD. Patient protection and affordable care act: promise and peril for primary care. Ann Intern Med. 2010;152(11):742-4.

    Google Scholar 

  3. Starfield B, Shi L, Mackino J. Contributions of primary care to health systems and health. Milbank Q. 2005;83:457–502.

    Article  PubMed  Google Scholar 

  4. Miller BF, Patel KK. Putting patients at the centre of health care in the US. Br J Gen Pract. 2011;61:471.

    Article  PubMed  Google Scholar 

  5. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic disease, and decrements in health: results from the world health surveys. Lancet. 2007;370:851–8.

    Article  PubMed  Google Scholar 

  6. Delamater A, Jacobson A, Anderson B, et al. Psychosocial therapies in diabetes: report of the psychosocial therapies working group. Diabetes Care. 2001;24:1286–92.

    Article  PubMed  CAS  Google Scholar 

  7. •• Ciechanowski P, Russo J, Katon WJ, et al. Relationship styles and mortality in patients with diabetes. Diabetes Care. 2010;33(3):539–44. Relationship styles play a profound role in health outcomes. In a sample of 3,535 patients, researchers found that a lower propensity to reach out to others for support is associated with higher mortality over a 5 year period. The authors’ conclude that relationship style is an important variable in examining mortality and outcomes, and future studies should look at interventions based upon different relational styles.

    Article  PubMed  Google Scholar 

  8. Gonder-Frederick LA, Cox DJ, Ritterband LM. Diabetes and behavioral medicine: the second decade. J Consult Clin Psychol. 2002;70:611–25.

    Article  PubMed  Google Scholar 

  9. Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299:2751–9.

    Article  PubMed  Google Scholar 

  10. Institute of Medicine. Committee on crossing the quality chasm: adaptation to mental health and addictive disorders. Natl Acad Sci. Washington, DC: National Academies Press, US; 2006.

  11. Petterson S, Phillips B, Bazemore A, Dodoo M, Zhang X, Green LA. Why there must be room for mental health in the medical home. Am Fam Physician. 2008;77(6):757.

    PubMed  Google Scholar 

  12. deGruy F. Mental health care in the primary care setting. In: Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, editors. Primary care: America's health in a new era. Washington, DC: Institute of Medicine; 1996.

    Google Scholar 

  13. Green CA, Perrin NA, Polen MR, Leo MC, Hibbard JH, Tusler M. Development of the patient activation measure for mental health. Adm Policy Ment Health. 2010;37(4):327-33.

    Google Scholar 

  14. Tsai AC, Morton SC, Mangione CM, Keeler EB. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005;11:478–88.

    PubMed  Google Scholar 

  15. Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009;28(1):75–85.

    Article  Google Scholar 

  16. Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(5 Suppl):1473–8.

    PubMed  Google Scholar 

  17. American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). Joint principles of the patient-centered medical home. 2007; http://www.medicalhomeinfo.org/Joint%20Statement.pdf Accessed August 13, 2009.

  18. •• Bojadzievski T, Gabbay RA. Patient-centered medical home and diabetes. Diabetes Care. 2011;34(4):1047–53. This review paper discusses the outcomes of several PCMH demonstration projects and their effects on diabetes outcomes.

    Article  PubMed  Google Scholar 

  19. Grumbach K, Bodenheimer T, Grundy P. The outcomes of implementing patient-centered medical home interventions: a review of the evidence on quality, access and costs from recent prospective evaluation studies. Washington, DC: Patient-Centered Primary Care Collaborative; 2012. http://www.pcpcc.net/resources. Accessed 8 June 2012.

    Google Scholar 

  20. Office of the Congressional Budget. An analysis of the literature on disease management programs. Washington, CBO; 2004.

  21. Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–23.

    Article  PubMed  CAS  Google Scholar 

  22. Regier DA, Narrow WE, Rac DS, Manderscheid RW, Locke B, Goodwin F. The de facto US mental health and addictive disorders service system: epidemiologic catchment area prospective. Arch Gen Psychiatry. 1993;50:85–94.

    Article  PubMed  CAS  Google Scholar 

  23. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):629–40.

    Article  PubMed  Google Scholar 

  24. Collins C, Hewson DL, Munger R, Wade T. Evolving models of behavioral health integration in primary care. 2010.

    Book  Google Scholar 

  25. Dickinson WP, Miller BF. Comprehensiveness and continuity of care and the inseparability of mental and behavioral health from the patient-centered medical home. Fam Syst Health. 2010;28(4):348–55.

    Article  PubMed  Google Scholar 

  26. Blount A. Integrated primary care: organizing the evidence. Fam Syst Health. 2003;21(2):121–33.

    Article  Google Scholar 

  27. Butler M, Kane RL, McAlpin D, et al. Integration of mental health/substance abuse and primary care no. 173 (Prepared by the Minnesota evidence-based practice center under contract no. 290-02-0009.) AHRQ publication No. 09-E003. Rockville: Agency for Healthcare Research and Quality; 2008.

    Google Scholar 

  28. Craven M, Bland R. Better practices in collaborative mental health care: an analysis of the evidence base. Can J Psychiatr. 2006;51(6 Suppl 1):7s–72s.

    Google Scholar 

  29. Fries JF, Koop CE, Beadle CE, et al. Reducing health care costs by reducing the need and demand for medical services. N Engl J Med. 1993;329(5):321–5.

    Article  PubMed  CAS  Google Scholar 

  30. Glasgow R, Toobert D, Gillette C. Psychosocial barriers to self-management and quality of life. Diabetes Spectrum. 2001;14:33–41.

    Article  Google Scholar 

  31. Yarnall KSH, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4):635–41.

    Article  PubMed  Google Scholar 

  32. Miller BF, Teevan B, Phillips RL, Petterson SM, Bazemore AW. The importance of time in treating mental health in primary care. Fam Syst Health. 2011;29(2):144–5.

    Article  PubMed  Google Scholar 

  33. Lustman P, Gavard JA. Psychosocial aspects of diabetes in adult populations. Washington, DC: United States Public Health Service, National Institute of Diabetes and Digestive and Kidney Diseases; 1995.

    Google Scholar 

  34. Lowes L, Gregory JW, Lyne P. Newly diagnosed childhood diabetes: a psychosocial transition for parents? J Adv Nurs. 2005;50(3):253–61.

    Article  PubMed  Google Scholar 

  35. Delamater AM. Improving patient adherence. Clin Diabetes. 2006;24(2):71–7.

    Article  Google Scholar 

  36. Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson Jr LA. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361–7.

    Article  PubMed  Google Scholar 

  37. Leff B, Reider L, Frick KD, et al. Guided care and the cost of complex healthcare: a preliminary report. Am J Manag Care. 2009;15(8):555–9.

    PubMed  Google Scholar 

  38. Pennsylvania Chronic Care Initiative. www.pcppc.net/content/pennsylvania-chronic-care-initiative. Accessed July 9, 2012.

  39. McCarthy D NR, Mika S, Wrenn J, Wakefield M. The North Dakota experience: achieving high-performance health care through rural innovation and cooperation. The Commonwealth Fund. 2008.

  40. Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235–45.

    Article  Google Scholar 

  41. Weber V, Bloom F, Pierdon S, Wood C. Employing the electronic health record to improve diabetes care: a multifaceted intervention in an integrated delivery system. J Gen Intern Med. 2008;23(4):379–82.

    Article  PubMed  Google Scholar 

  42. Shahady EJ. Creating a participatory office practice for diabetes care. J Participat Med. 2011;4(3):e18.

    Google Scholar 

  43. Miller BF, Kessler R, Peek CJ, Kallenberg GA. A national research agenda for research in collaborative care: papers from the collaborative care research network research development conference. AHRQ Publication No. 11-0067. 2011. http://www.ahrq.gov/research/collaborativecare/.

  44. Tapp H, Phillips SE, Waxman D, Alexander M, Brown R, Hall M. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic. J Am Board Family Med: JABFM. 2012;25(2):245–6.

    Article  Google Scholar 

  45. Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabet Med: J British Diabet Assoc. 2008;25(9):1096–101.

    Article  CAS  Google Scholar 

  46. Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care. 2007;30(3):542–8.

    Article  PubMed  Google Scholar 

  47. Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28(3):626–31.

    Article  PubMed  Google Scholar 

  48. Shojania KG, Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA: J Am Med Assoc. 2006;296(4):427–40.

    Article  CAS  Google Scholar 

  49. Reid RJ, Coleman K, Johnson EA, et al. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835–43.

    Article  Google Scholar 

  50. Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaen C. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health Aff (Millwood). 2011;30(3):439–45.

    Article  Google Scholar 

  51. McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff (Millwood). 2010;29(5):982–90.

    Article  Google Scholar 

  52. Kathol RG, Butler M, McAlpine DD, Kane RL. Barriers to physical and mental condition integrated service delivery. Psychosom Med. 2010;72(6):511–8.

    Article  PubMed  Google Scholar 

  53. Mauch D, Kautz C, Smith SA. Reimbursement of mental health services in primary care settings. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2008. HHS Pub. No. SMA-08-4324.

    Google Scholar 

  54. •• Crabtree BF, Nutting PA, Miller WL, Stange KC, Stewart EE, Jaen CR. Summary of the national demonstration project and recommendations for the patient-centered medical home. Ann Fam Med. 2010;8 Suppl 1:S80–90. S92. This paper describes the major outcomes of the PCMH National Demonstration Project, a national randomized test of implementation of a specific PCMH model or self-direction into 36 family practices. The paper also makes recommendations for translation of the results into primary care practice.

    Article  PubMed  Google Scholar 

  55. Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15(9):e71–87.

    PubMed  Google Scholar 

  56. Health care system "In pursuit of excellence" case example. www.aha.org/about/membership/constituency/hcs/sentara.shtml. Accessed June 15, 2012.

  57. Unutzer J, Chan YF, Hafer E, et al. Quality improvement with pay-for-performance incentives in integrated behavioral health care. Am J Public Health. 2012;102(6):e41–5.

    Article  PubMed  Google Scholar 

  58. Williams JW, Jackson GL, Powers BJ, Chatterjee R, Prvu Bettger J, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R. The patient-centered medical home. Closing the quality gap: revisiting the state of the science. AHRQ Publication No. 12-E008-EF. Rockville, MD. Agency for Healthcare Research and Quality. July 2012. Evidence Report No. 208.

  59. Cunningham PJ. Beyond parity: primary care physicians' perspectives on access to mental health care. Heal Aff. 2009;28(3):w490–501.

    Article  Google Scholar 

  60. Blumenthal D. Launching HITECH. N Engl J Med. 2010;362(5):382–5.

    Article  PubMed  CAS  Google Scholar 

  61. • Glasgow RE, Kaplan RM, Ockene JK, Fisher EB, Emmons KM. Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records. Health Aff (Millwood). 2012;31(3):497–504. This paper recommends specific patient psychosocial measures that should be routine data collected through an electronic health record. These measures could enhance the patient-provider relationship and provide important population-based data.

    Article  Google Scholar 

  62. Peek CJ. Planning care in the clinical, operational, and financial worlds. In: Kessler R, Stafford D, editors. Collaborative medicine case studies: evidence in practice. New York: Springer; 2008.

    Google Scholar 

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Disclosure

Conflicts of interest: B. T. Jortberg, none; B. F. Miller, none; R. A. Gabbay, none. K. Sparling: has been a consultant for Animas Corporation and Lifespan Corporation; has received honoraria (contracted speaker) and consulting fees (TV commercial) from Animas Corporation; has received payment for development of educational presentations, including service on speakers' bureaus from the Juvenile Diabetes Research Foundation; has received travel/accommodations expenses covered or reimbursed from Animas Corporation and Juvenile Diabetes Research Foundation; is a columnist for Web page for dLIFE, diatribe, Juvenile Diabetes Research Foundation, and Animas Corporation (columnist for Web page and videos); has been a consultant in documentary for Novo Nordisk; has contract writing for WEGOHealth and CVS; has speaking engagements for Johnson & Johnson; and has been a consultant for Roche. W. P. Dickinson has received grant support from NIDDK.

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Authors and Affiliations

  1. Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, AO1, 12631 E. 17th Ave., Room 3519, Aurora, CO, 80045-0508, USA

    Bonnie T. Jortberg, Benjamin F. Miller & W. Perry Dickinson

  2. Division of Endocrinology, Diabetes and Metabolism, Penn State Institute for Diabetes, Obesity, Pennsylvania State College of Medicine, 500 University Drive, Hershey, PA, 17036, USA

    Robert A. Gabbay

  3. Patient Advocate, 716 Centre of New England Blvd, Coventry, RI, 02816, USA

    Kerri Sparling

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  1. Bonnie T. Jortberg
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  2. Benjamin F. Miller
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Correspondence to Bonnie T. Jortberg.

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Jortberg, B.T., Miller, B.F., Gabbay, R.A. et al. Patient-Centered Medical Home: How It Affects Psychosocial Outcomes for Diabetes. Curr Diab Rep 12, 721–728 (2012). https://doi.org/10.1007/s11892-012-0316-1

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