Journal of General Internal Medicine

, Volume 28, Issue 9, pp 1188–1194

Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations

  • Jean Yoon
  • Danielle E. Rose
  • Ismelda Canelo
  • Anjali S. Upadhyay
  • Gordon Schectman
  • Richard Stark
  • Lisa V. Rubenstein
  • Elizabeth M. Yano
Original Research

DOI: 10.1007/s11606-013-2405-5

Cite this article as:
Yoon, J., Rose, D.E., Canelo, I. et al. J GEN INTERN MED (2013) 28: 1188. doi:10.1007/s11606-013-2405-5

Abstract

Background

As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings.

Objective

We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations.

Design

Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year.

Participants

2,853,030 patients from 814 VHA primary care clinics

Main Measures

Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®.

Key Results

The overall mean home builder score in the study clinics was 88 (SD = 13) or 69 %. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3 % (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074).

Conclusion

Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.

KEY WORDS

medical home avoidable hospitalizations access care coordination 

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Jean Yoon
    • 1
    • 2
  • Danielle E. Rose
    • 3
  • Ismelda Canelo
    • 3
  • Anjali S. Upadhyay
    • 1
  • Gordon Schectman
    • 7
  • Richard Stark
    • 7
  • Lisa V. Rubenstein
    • 3
    • 4
    • 5
  • Elizabeth M. Yano
    • 3
    • 6
  1. 1.Health Economics Resource CenterVA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.Center for Health Care EvaluationVA Palo Alto Health Care SystemMenlo ParkUSA
  3. 3.Center for Center of Excellence for the Study of Healthcare Provider BehaviorVA Greater Los AngelesSepulvedaUSA
  4. 4.UCLA School of MedicineLos AngelesUSA
  5. 5.RAND CorpSanta MonicaUSA
  6. 6.UCLA School of Public HealthLos AngelesUSA
  7. 7.Patient Care ServicesVeterans Health AdministrationWashingtonUSA

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