The Patient Centered Medical Home and Receipt of Diabetes Management Services Open Access

Jepeal, Nicole Marie (2016)

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The Patient-Centered Medical Home (PCMH) is a model of primary care delivery that is thought to be particularly suited to the management of chronic diseases, including diabetes. However, studies have found mixed results regarding whether it improves the quality of patient care. The PCMH does not have a consistent definition in research literature, with most PCMH studies testing the adoption of a specific PCMH intervention. There is a lack of studies which examine the PCMH from the perspective of the patient. To address this gap in the literature, components of the PCMH will be tested for association with better diabetes management. Components will be measured from the perspective of patterns of care experienced by the patient. All respondents of the Diabetes Care Survey component of the 2012 Medical Expenditure Panel Survey (MEPS) will be included in the study. Logistic, ordered logistic, and multinomial logistic regression models will be used to test four PCMH components: personal provider, whole-person orientation, coordinated/integrated care, and enhanced access against measures of the quality of diabetes management including receipt of annual A1C testing, cholesterol screening, foot exams, eye exams, and flu shots. Having a person provider was associated with an increased likelihood of receiving any and four A1C tests, a foot exam, a cholesterol test, a flu shot, and all five services. There was no association between whole person orientation or coordinated/integrated care and any of the diabetes outcomes measures. Enhanced access was negatively associated with the receipt of an annual cholesterol test or flu vaccine. The findings indicate that the processes driving improvements in diabetes care quality may not be visible to the patient. In addition, the difficulty in measuring the PCMH suggests that provider organizations and government agencies may need to rethink conceptualization of the model.

Table of Contents

Chapter I. Introduction 1

Chapter II. Literature Review 3

Figure 1. Joint Principles of the Patient Centered Medical Home 7

Figure 2. AHRQ conceptual framework for the effectiveness of the medical home 9

Table 1. Summary of research on effects of PCMH on diabetes management 11

Chapter III. Methods 14

Figure 3. Study sample inclusion criteria 15

Table 2. Independent and Dependent Variable Operational Definitions 19

Fig 4. Conceptual model for the relationship between the Patient-Centered Medical Home and use of diabetes management services 23

Table 3. Key Variable Measures 24

Chapter IV. Results 28

Table 4. Characteristics of 2012 MEPS participants who completed the diabetes care survey 29

Table 5. Frequency of receipt of diabetes management services by PCMH component 31

Table 6. Summary of regression results 33

Table 7. Marginal effects of usual source of care on the likelihood of receiving DMS 34

Table 8. Marginal effects of whole person orientation on the likelihood of receiving DMS 37

Table 9. Marginal effects of coordinated care on the likelihood of receiving DMS 42

Table 10. Marginal effects of enhanced access on the likelihood of receiving DMS 46

Chapter V. Disussion 50

References 56

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