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Empirical research

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

Authors:

Tracy Marie Anastas,

Oregon Health and Science University, US
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Jesse Wagner,

Oregon Health and Science University, US
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Rachel Lauren Ross,

Oregon Health and Science University, US
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Bhavaya Sachdeva,

Oregon Health and Science University, US
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LeAnn Michaels,

Oregon Health and Science University, US
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Kimberley Gray,

Oregon Health and Science University, US
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Katie Cartwright,

Oregon Health and Science University, US
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David A. Dorr

Oregon Health and Science University, US
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Abstract

Introduction: Like most patient-centered medical home (PCMH) models, Oregon’s program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization.

Methods: We performed a targeted literature review of each PCPCH core attribute. Value-related concepts and their metrics were abstracted, and studies were assessed for relevance and strength of evidence. Focus groups were held with stakeholders and patients, and themes related to each attribute were identified; calculation of HVE attainment versus PCPCH criteria were completed on eight primary care clinics. Analyses consisted of descriptive statistics and criterion validity with stakeholder input.

Results: 2,126 abstracts were reviewed; 22 met inclusion criteria. From these articles and focus groups of stakeholders/experts (n = 49; 4 groups) and patients (n = 7; 1 group), 12 HVEs were identified that may reduce cost and utilization. At baseline, clinics achieved, on average, 31.3 percent HVE levels compared to an average of 87.9 percent of the 35 PCMH measures.

Discussion: A subset of measures from the PCPCH model were identified as “high value” in reducing cost and utilization. HVE performance was significantly lower than standard measures, and may better calibrate clinic ability to reduce costs.

Conclusion: Through literature review and stakeholder engagement, we created a novel set of high value elements for advanced primary care likely to be more related to cost and utilization than other models.

How to Cite: Anastas TM, Wagner J, Ross RL, Sachdeva B, Michaels L, Gray K, et al.. Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2019;7(1):20. DOI: http://doi.org/10.5334/egems.246
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  Published on 03 May 2019

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