Researchers analyzed how patients with handled hypertension used outpatient specialized good care before, during, and after a primary care upgrade was spread system-wide. Patients with hypertension and few other circumstances had 27-28 % less specialized trips in each of the three years after upgrade implementation began, in comparison to earlier. Those with some other diseases had 9 % less specialized visits during healthcare home execution and 5 % less specialized trips during the following years.
"Redesigning proper want to a healthcare home let primary-care groups do more, within their expertise, for their patients," Dr. Liss said. "Our results suggest this can avoid or prevent some specialized visits for patients with constant hypertension and a few co-occurring diseases." He analyzed more than 36,000 patients with handled hypertension in Group Health's 26 medical centers.
Patients with hypertension and few other circumstances had 27-28 % less specialized visits in each of the three years after the medical home began being applied, in comparison to earlier, adjusting for potential confounders and such as interaction results. Those with some other diseases had 9 % less specialized visits during medical home execution and 5 % less specialized visits during the following year.
"In contrast, we found different results for clinically complicated patients overwhelmed by multiple diseases as well as hypertension," said Dr. Liss's coauthor John Reid, MD, PhD, a senior investigator at Group Health Research Institution, and an adjunct professor at the University of Washington (UW) School of Public Health and Community Medicine. For those patients, specialized use was 3 % and 5 % higher, respectively, during the first and second years after the medical home was applied.
"This suggests a need for more effective co-management and better 'handoffs' of complicated patients by main good care teams and specialists in the 'medical neighborhood' that encompasses the medical home," Dr. Reid said. "We think new approaches to managing good care between main good care teams and specialists should give priority to complicated patients."
A patient-centered medical home is an increasingly common way to increase the results of good main care: It's like having a doctor who knows the patients and leads a team of professionals making the most of current knowledge and technology -- such as email and electronic health records -- to deliver first-rate, synchronized main good care and reach out to help patients keep in good health. Dr. Reid has published assessments of Group Health's medical home execution, connecting it to emergency room use.
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