Impact of Patient-Centered Medical Home Assignment on Emergency Room Visits Among Uninsured Patients in a County Health System

University of California-Los Angeles, UCLA School of Public Health, Department of Health Services & Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, USA.
Medical Care Research and Review (Impact Factor: 2.62). 08/2010; 67(4):412-30. DOI: 10.1177/1077558710368682
Source: PubMed


The Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.

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    • "Some studies have, in fact, shown that single-handed GP practices are associated (albeit weakly) with greater utilization of hospital emergency rooms (Gulliford, Jack, Adams, & Ukoumunne, 2004). More recently, evaluations of the medical home model have suggested that well-functioning medical homes reduce the number of visits to the ER by child and adult patients (Cooley, McAllister, Sherrieb, & Kuhlthau, 2009; Gilfillan et al 2010; O'Malley, 2013; Reid et al. 2010; Roby et al., 2010). In our study, therefore , we hypothesize the following: "
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    Medical Care Research and Review 07/2014; 71(4):315-336. DOI:10.1177/1077558714536618 · 2.62 Impact Factor
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    • "However, the patient experience survey data relied on a 20% response rate, making it impossible to know whether that deterioration was real. Both Roby et al. (2010) and Diedhiou et al. (2010) reported fewer emergency department visits among patients receiving care in a medical home, but in neither case was it clear that the comparison group was similar to the intervention group in these observational studies. These and earlier studies are suggestive , as are international comparisons, but a skeptic would like more convincing evidence before accepting medical homes as the solution to our health care problems. "
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    The Journal of ambulatory care management 01/2011; 34(1):3-9. DOI:10.1097/JAC.0b013e3181ff7040
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    ABSTRACT: This report examines the role of the primary care medical home in Healthy San Francisco, a health care access program for uninsured adults in the city and county of San Francisco. The program’s medical home requirement—and its associated referral system—appear to have conferred several benefits to San Francisco’s safety-net delivery system, including strengthening ties between the uninsured people and their particular medical home, and allowing providers to focus on the health of a panel of patients. However, participants and providers also reported some concerns with the program, indicating areas for improvement in the future.
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