February 3, 2014

Hypertensive patients’ specialty use changed with medical home

Use fell for healthier patients—but rose for ‘complex’ patients with many other diseases

 

Seattle, WA—Group Health studied how patients with treated hypertension used outpatient specialty care before, during, and after a primary-care redesign (the patient-centered medical home) was spread system-wide. David T. Liss, PhD, now a research assistant professor in medicine-general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, led the report in the Journal of General Internal Medicine.

“Redesigning care to a medical home seems to let primary-care teams do more, within their expertise, for their patients,” Dr. Liss said. “Our results suggest this can avoid or prevent some specialty visits for patients with stable hypertension and a few co-occurring illnesses.” He studied more than 36,000 patients with treated hypertension in Group Health’s 26 medical centers.

Patients with hypertension and few other conditions had 27-28 percent fewer specialty visits in each of the three years after the medical home started being implemented, compared to beforehand, adjusting for potential confounders and including interaction effects. Those with some other illnesses had 9 percent fewer specialty visits during medical home implementation and 5 percent fewer specialty visits during the following year.

Robert Reid, MD, PhD“In contrast, we found very different results for clinically complex patients burdened by multiple diseases in addition to hypertension,” said Dr. Liss’s coauthor Robert Reid, MD, PhD, a senior investigator at Group Health Research Institute, and an adjunct professor at the University of Washington (UW) School of Public Health and Community Medicine. For those patients, specialty use was 3 percent and 5 percent higher, respectively, during the first and second years after the medical home was implemented.

“This suggests a need for more effective co-management and better ‘handoffs’ of complex patients by primary care teams and specialists in the ‘medical neighborhood’ that surrounds the medical home,” Dr. Reid said. “We think new approaches to coordinating care between primary care teams and specialists should give priority to complex patients.”

A patient-centered medical home is an increasingly common way to amplify the effects of good primary care: It’s like having a family doctor who knows the patients and leads a team of professionals making the most of current knowledge and technology—including e-mail and electronic health records—to deliver first-rate, coordinated primary care and reach out to help patients stay healthy. Dr. Reid has published evaluations of Group Health’s medical home implementation, linking it to emergency room use.

The National Center for Advancing Translational Sciences (#TL1 RR025016), the Agency for Healthcare Research and Quality (#R18 HS019129), and Group Health Cooperative funded this research.

Paul A. Fishman, PhD
P. Fishman
PhD

Carolyn M. Rutter, PhD
C. Rutter
PhD
Drs. Liss and Reid’s coauthors were David Grembowski, PhD, of the UW School of Public Health and Community Medicine; and Paul A. Fishman, PhD, Carolyn M. Rutter, PhD, and Tyler R. Ross, MA, of Group Health Research Institute.

Journal of General Internal Medicine
The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine. It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine. Its articles focus on topics such as clinical medicine, epidemiology, prevention, health care delivery, curriculum development and numerous other non-traditional themes, in addition to classic clinical research on problems in internal medicine.

Northwestern University Feinberg School of Medicine
Northwestern University Feinberg School of Medicine, founded in 1859, attracts talented individuals to its faculty, staff, and student body through its cutting-edge research initiatives, superb clinical affiliates, global outlook, and innovative curriculum. Located in the heart of Chicago’s Magnificent Mile, Feinberg has built a national reputation for excellence through a strong history of collaborative, interdisciplinary medical education and research, and along with Northwestern Memorial Hospital and Northwestern Medical Group is part of the premier academic medical center known as Northwestern Medicine. Feinberg stands out among the nation's research-intensive medical schools and consistently receives high marks in U.S. News & World Report surveys. Through its affiliates, it provides patient care to thousands of individuals every year, and plays an integral part in the communities it serves.

Group Health Research Institute
Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Now celebrating its 30th anniversary year, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems since 1983. Government and private research grants provide its main funding.

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