TY - JOUR
T1 - INTEGRATING POPULATION HEALTH STRATEGIES INTO PRIMARY CARE
T2 - IMPACT ON OUTCOMES AND HOSPITAL USE FOR LOW-INCOME ADULTS
AU - Kitzman, Heather
AU - Tecson, Kristen
AU - Mamun, Abdullah
AU - da Graca, Briget
AU - Yeramaneni, Samrat
AU - Halloran, Kenneth
AU - Wesson, Donald
N1 - Publisher Copyright:
© 2022 Ethnicity and Disease, Inc.. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Objective: Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also investigated associations between these outcomes and emergency department (ED) and inpatient (IP) use and costs. Design: Retrospective cohort. Setting: Community-based PCMH: Baylor Scott & White Health and Wellness Center (BSW HWC). Patients/Participants: All patients who attended at least two primary care visits at BSW HWC within a 12-month time span from 2011-2015. Methods: Outcomes for patients participating in PCMH only (PCMH) as compared to PCMH plus population health services (PCMH+PoPH) were compared using electronic health record data. Main Outcomes: Diastolic and systolic blood pressure, hemoglobin A1c, ED visits and costs, and IP hospitalizations and costs were examined. Results: From 2011-2015, 445 patients (age=46±12 years, 63% African American, 61% female, 69.5% uninsured) were included. Adjusted regression analyses indicated PCMH+PoPH had greater improvement in diabetes outcomes (prediabetes HbA1c= -.65[SE= .32], P = .04; diabetes HbA1c = -.74 [SE= .37], P < .05) and 37% lower ED costs than the PCMH group (P= .01). Worsening chronic disease risk factors was associated with 39% higher expected ED visits (P < .01), whereas improved chronic disease risk was associated with 32% fewer ED visits (P= .04). Conclusions: Integrating population health services into the PCMH can improve chronic disease outcomes, and impact hospital utilization and cost in un- or under-insured populations.
AB - Objective: Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also investigated associations between these outcomes and emergency department (ED) and inpatient (IP) use and costs. Design: Retrospective cohort. Setting: Community-based PCMH: Baylor Scott & White Health and Wellness Center (BSW HWC). Patients/Participants: All patients who attended at least two primary care visits at BSW HWC within a 12-month time span from 2011-2015. Methods: Outcomes for patients participating in PCMH only (PCMH) as compared to PCMH plus population health services (PCMH+PoPH) were compared using electronic health record data. Main Outcomes: Diastolic and systolic blood pressure, hemoglobin A1c, ED visits and costs, and IP hospitalizations and costs were examined. Results: From 2011-2015, 445 patients (age=46±12 years, 63% African American, 61% female, 69.5% uninsured) were included. Adjusted regression analyses indicated PCMH+PoPH had greater improvement in diabetes outcomes (prediabetes HbA1c= -.65[SE= .32], P = .04; diabetes HbA1c = -.74 [SE= .37], P < .05) and 37% lower ED costs than the PCMH group (P= .01). Worsening chronic disease risk factors was associated with 39% higher expected ED visits (P < .01), whereas improved chronic disease risk was associated with 32% fewer ED visits (P= .04). Conclusions: Integrating population health services into the PCMH can improve chronic disease outcomes, and impact hospital utilization and cost in un- or under-insured populations.
KW - Chronic Disease
KW - Health Disparities
KW - Low-Income
KW - Patient-Centered Medical Home
KW - Population Health
KW - Uninsured
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UR - http://www.scopus.com/inward/citedby.url?scp=85129781912&partnerID=8YFLogxK
U2 - 10.18865/ED.32.2.91
DO - 10.18865/ED.32.2.91
M3 - Article
C2 - 35497399
AN - SCOPUS:85129781912
SN - 1049-510X
VL - 32
SP - 91
EP - 100
JO - Ethnicity and Disease
JF - Ethnicity and Disease
IS - 2
ER -