Implementation of the patient-centered medical-home model of care coupled with an infrastructure of multipayer support "holds significant promise to improve diabetes care," according to a report in the Joint Commission Journal on Quality and Patient Safety
written by researchers from the Penn State College of Medicine, Hershey, and the University of Pittsburgh.
Diabetes care data was collected between May 2008 and May 2009 from 143 primary-care providers at 25 practices that were participating in a regional collaborative initiative in southeast Pennsylvania. Philadelphia practices were included in the study.
The practices had an average Medicaid enrollment of 35.2%, and 76% had 100-500 diabetics in their patient population. By the end of the year, 12 had achieved some level of National Committee for Quality Assurance medical home recognition
. (Those practices were part of a larger effort involving 105 practices, 382 providers and six payers and four regional collaboratives. The effort has grown to 152 practices with 644 providers.)
"There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality," the researchers wrote.
According to the report, in the collaborative studied, the percentage of patients receiving an annual foot exam rose to 69% from 50%; the percentage of patients receiving statins increased to 57% from 36%; and patients receiving angiotensin receptor blockers or angiotensin-converting enzyme inhibitors increased to 56% from 42%. These led to "small but statistically significant improvements" in cholesterol levels (8.5%) and blood pressure (4%).
"There was significant reduction among these highest-risk individuals for the three most critical diabetes clinical parameters: glycemic control, blood pressure and cholesterol," the researchers wrote. "Reductions for those patients furthest from target—and typically those patients associated with highest cost of care—hold significant promise for reducing overall healthcare costs."
The report also noted that another study is assessing different payment approaches used in the collaboratives, which including a per member per month care-management fee and shared savings formulas.
"This is one of the largest multipayer (patient-centered medical-home) programs in the country and can serve as a model for how to revitalize primary care and improve the health of patients across the country," said lead author Dr. Robert Gabbay, professor of medicine at the Penn State College of Medicine and director of the college's Hershey Diabetes and Obesity Institute, in a Penn State news release