Multipayer patient-centered medical homes may boost health outcomes for diabetes patients

NEW YORK — A new report published in the June issue of the Joint Commission Journal on Quality and Patient Safety found that diabetes patients can benefit from multipayer patient-centered medical homes.

More than 10,000 patients — assessed by Robert Gabbay, professor of medicine at Penn State College of Medicine and director of the Penn State Institute for Diabetes and Obesity in Hershey, Pa., and colleagues — were enrolled in a broad-scale chronic care model of PCMH, a setting that aims to provide "comprehensive primary care that is coordinated and integrated across all elements of the healthcare system by a physician-led team of individuals who have an ongoing relationship with the patient and, when appropriate, the patient’s family," Gabbay said.

The researchers found that in the first year of intervention, evidence-based care guideline adherence and clinical outcomes saw improvements. For example, patients that received yearly foot assessments for neuropathy — as part of the PCMH mulitpayer initiative — significantly increased from 50% to 69%. Similarly, patients receiving annual screenings for nephropathy and diabetic retinopathy, as well as administration of pneumonia and influenza vaccines, also improved.

Additional improvements were found among high-risk patients, including:

  • An 8.5% absolute increase in the percentage of patients with an LDL cholesterol level under 130;

  • A 4% absolute increase in the percentage of patients with blood pressure under 140/90; and

  • A 2.5% absolute decrease in the percentage of patients with HbA1C above 9.

The first-year outcomes were pooled from 25 participating practices and 143 participating providers in the Southeast region of Pennsylvania, which focused on diabetes patients.

Gabbay noted that despite the significant health improvements among the diabetes patients, "over time, it will be important to continue to monitor the intervention to fully assess the impact of these improvements in clinical care on costs," he wrote.

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