Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration
- 275 Downloads
Given its widespread dissemination across primary care, the Veterans Health Administration (VA) is an ideal setting to examine the impact of the patient-centered medical home (PCMH) on diabetes outcomes.
To assess the impact of PCMH implementation on diabetes outcomes among patients receiving care in the Veterans Health Administration.
Retrospective cohort analysis and multilevel logistic regression.
Twenty thousand eight hundred fifty-eight patients in one Midwest VA network who had a diabetes diagnosis in both 2009 and 2012 and who received primary care between October 1, 2008 and September 30, 2009.
Glycemic and lipid control using VA quality indicators [hemoglobin (Hb) A1c < 9%, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL].
Odds of glycemic control were lower in 2012 than 2009 (OR = 0.72, 95% CI = 0.67–0.77, p < 0.001), and this change in control over time varied by race (OR of the interaction between time and race = 1.18, 95% CI = 1.02–1.36, p = 0.028). While the disparity in glycemic control between white and black patients persisted post-PCMH, the magnitude of the disparity was smaller in 2012 compared to 2009 (2012: OR = 1.32, 95% CI = 1.18–1.47, p < 0.0001 and 2009: OR = 1.59, 95% CI = 1.39–1.82, p < 0.0001). Odds of lipid control did not significantly change between 2009 and 2012 and change did not vary by race and/or gender.
Although there were no significant improvements in odds of lipid control, and odds of glycemic control decreased following PCMH implementation, there was evidence of reduced racial disparities in glycemic control post-PCMH implementation.
KEY WORDSdiabetes disparities race and ethnicity veterans patient-centered outcomes research
This work was funded through a contract between VA Network 12 and investigators at the Center for Innovation in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center. The funding source had no involvement in any aspect of the study design except the initial research question and was not involved in data collection, analysis, or interpretation. We are grateful to the VA Network 12 for their commission and support of this work and to Mark Kuebeler for his statistical support.
Compliance with Ethical Standards
This research was approved by the Baylor College of Medicine Institutional Review Board.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Wahowiak L. The VA’s focus on diabetes care, research, and training. Veterans and Diabetes [Diabetes Forecast web site]. December, 2014: Available at: http://www.diabetesforecast.org/2014/12-dec/veterans-and-diabetes.html?referrer=https://outlook.live.com/.
- 2.Centers for Disease Control Prevention (CDC). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.Google Scholar
- 4.Rosland AM, Nelson K, Sun H, et al. The patient-centered medical home in the Veterans Health Administration. Am J Manag Care.2013;19:263–72.Google Scholar
- 5.Petzel RA. Patient Aligned Care Team (PACT) Handbook. Department of Veterans Affairs, Veterans Health Administration. 2014.Google Scholar
- 7.Nelson KM, Helfrich C, Sun H, et al. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med.2014;174:1350–8.CrossRefPubMedGoogle Scholar
- 10.Bodjadzievski T, Gabbay R. Patient-centered medical home and diabetes. Med Care.2011;34: 1047–53.Google Scholar
- 16.Women Veterans Health Strategic Health Care Group. Gender Differences in Performance Measures, VHA 2008–2011. Washington, DC: Veterans Health Administration; 2012.Google Scholar
- 18.Office of Quality and Performance. FY 2011 Q1 Clinical Measures Specification Manual. Vol. 2. Veterans Health Administration; Oct 1. 2010.Google Scholar
- 21.Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
- 32.Health Affairs. Racial and Ethnic Disparities Persist at Veterans Health Administration Patient-Centered Medical Homes. Available at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0029. Accessed December 18, 2017.
- 38.Beal A, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the divide: how medical homes promote equity in health care: The Commonwealth Fund June 2007.Google Scholar
- 43.US Department of Veterans Affairs. National Center for Veterans Analysis and Statistics. Washington, DC: US Department of Veterans Affairs; Statistics at a Glance (August 2014).Google Scholar