Capsule Commentary on Woodard et al., Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration

Capsule Commentary on Woodard et al., Impact of Patient-Centered Medical Home Implementation on... Capsule Commentary on Woodard et al., Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration Lisa Stehno-Bittel, PhD and Lisa VanHoose, PhD, MPH, MSPT University of Kansas Medical Center, Kansas City, KS, USA. J Gen Intern Med 33(8):1384 increased significantly, a recent systematic review reported DOI: 10.1007/s11606-018-4509-4 that the number of high quality publications are limited . © Society of General Internal Medicine 2018 While PACT had no impact on diabetic outcomes, Woodward et al. supports previous publications suggesting small im- provements toward health equity with PACT that are promis- ing and should continue to be investigated. ince the induction of the Affordable Care Act, care out- comes for Patient-Centered Medical Homes (PCMH) Corresponding Author: Lisa Stehno-Bittel, PhD; University of while important, have proven difficult to assess. The Veterans Kansas Medical Center, Kansas City, KS, USA (e-mail: lbittel@kumc. edu). Affairs Healthcare system version of the PCMH is the Patient- Aligned Care which was launched in 2010 and offers an Compliance with Ethical Standards: opportunity to compare outcomes to the traditional provider model that was in place prior to implementation of PACT. Conflict of Interest: The authors declare that they have no conflict of A previous study found significant improvement in lipid interest. values and blood pressure with PACT implementation in over 800 VA primary care clinics . The study reviewed here analyzed PACT’s impact on glycemic control among REFERENCES Midwestern veterans . The authors focused on two out- 1. Rosland, AM, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, comes as measures of the quality of care: glycemic control Nelson K. (2017). Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. (hemoglobinA1c < 9%) and lipid management (low-density Health Service Research, (epub).doi:https://doi.org/10.1111/1475-6773. lipoprotein cholesterol (LDL-C < 100 mg/dL). Tracking over 2. Woodard LD, Adepoju OE, Amspoker AB, Virani SS, Ramsey DJ, 20,000 diabetic patients demonstrated that the percentage that Petersen LA, Jones LA, Kiefer L, Mehta P, Naik AD. Impact of Patient- attained HbA1c levels below 9% declined in the PACT sys- Centered Medical Home Implementation on Diabetes Control in the tem, while LDL-C control improved slightly. However, this Veterans Health Administration. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-018-4386-x. improvement disappeared when adjusted for patient, provider, 3. Khunti K, Ceriello A, Cos X, DeBlock C. (2018). Achievement of guideline and facility. While the results should not be surprising, be- targets for blood pressure, lipid and glycaemic control in type 2 diabetes: A meta-analysis. Diabetes Research and Clinical Practice.1,137:137–148. cause in the general population only 29% of diabetics meet the 3 https://doi.org/10.1016/j.diabres.2017.12.004 target HbA1c levels , they do not suggest that PACT did better 4. Olayiwola, JN, Sheth S, Mleczko V, Choi AL, Sharma, AE. (2016). The than traditional models of care. Impact of the Patient-Centered Medical Home on Health Disparities in Adults: A Systematic Review of the Evidence. Journal of Health Disparities The authors also investigated the PACT’s influence on Research and Practice, 9(4), 68–96. https://digitalscholarship.unlv.edu/ gender and racial health disparities. A narrowing of the glyce- jhdrp/vol10/iss1/5 5. Yano EM, Haskell S, Hayes P. Delivery of Gender-Sensitive Comprehen- mic control gap between non-Hispanic White and Black pa- sive Primary Care to Women Veterans: Implications for VA Patient Aligned tients was reported. However, the difference was insignificant Care Teams. Journal of General Internal Medicine, 29(2): S703–707. with the introduction of gender into the model, which may be https://doi.org/10.1007/s11606-013-2699-3 due to heterogeneity of female primary care delivery within the VA system . Although PCMH/PACT adoption has Published online June 4, 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of General Internal Medicine Springer Journals

Capsule Commentary on Woodard et al., Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration

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Publisher
Springer US
Copyright
Copyright © 2018 by Society of General Internal Medicine
Subject
Medicine & Public Health; Internal Medicine
ISSN
0884-8734
eISSN
1525-1497
D.O.I.
10.1007/s11606-018-4509-4
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Abstract

Capsule Commentary on Woodard et al., Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration Lisa Stehno-Bittel, PhD and Lisa VanHoose, PhD, MPH, MSPT University of Kansas Medical Center, Kansas City, KS, USA. J Gen Intern Med 33(8):1384 increased significantly, a recent systematic review reported DOI: 10.1007/s11606-018-4509-4 that the number of high quality publications are limited . © Society of General Internal Medicine 2018 While PACT had no impact on diabetic outcomes, Woodward et al. supports previous publications suggesting small im- provements toward health equity with PACT that are promis- ing and should continue to be investigated. ince the induction of the Affordable Care Act, care out- comes for Patient-Centered Medical Homes (PCMH) Corresponding Author: Lisa Stehno-Bittel, PhD; University of while important, have proven difficult to assess. The Veterans Kansas Medical Center, Kansas City, KS, USA (e-mail: lbittel@kumc. edu). Affairs Healthcare system version of the PCMH is the Patient- Aligned Care which was launched in 2010 and offers an Compliance with Ethical Standards: opportunity to compare outcomes to the traditional provider model that was in place prior to implementation of PACT. Conflict of Interest: The authors declare that they have no conflict of A previous study found significant improvement in lipid interest. values and blood pressure with PACT implementation in over 800 VA primary care clinics . The study reviewed here analyzed PACT’s impact on glycemic control among REFERENCES Midwestern veterans . The authors focused on two out- 1. Rosland, AM, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, comes as measures of the quality of care: glycemic control Nelson K. (2017). Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. (hemoglobinA1c < 9%) and lipid management (low-density Health Service Research, (epub).doi:https://doi.org/10.1111/1475-6773. lipoprotein cholesterol (LDL-C < 100 mg/dL). Tracking over 2. Woodard LD, Adepoju OE, Amspoker AB, Virani SS, Ramsey DJ, 20,000 diabetic patients demonstrated that the percentage that Petersen LA, Jones LA, Kiefer L, Mehta P, Naik AD. Impact of Patient- attained HbA1c levels below 9% declined in the PACT sys- Centered Medical Home Implementation on Diabetes Control in the tem, while LDL-C control improved slightly. However, this Veterans Health Administration. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-018-4386-x. improvement disappeared when adjusted for patient, provider, 3. Khunti K, Ceriello A, Cos X, DeBlock C. (2018). Achievement of guideline and facility. While the results should not be surprising, be- targets for blood pressure, lipid and glycaemic control in type 2 diabetes: A meta-analysis. Diabetes Research and Clinical Practice.1,137:137–148. cause in the general population only 29% of diabetics meet the 3 https://doi.org/10.1016/j.diabres.2017.12.004 target HbA1c levels , they do not suggest that PACT did better 4. Olayiwola, JN, Sheth S, Mleczko V, Choi AL, Sharma, AE. (2016). The than traditional models of care. Impact of the Patient-Centered Medical Home on Health Disparities in Adults: A Systematic Review of the Evidence. Journal of Health Disparities The authors also investigated the PACT’s influence on Research and Practice, 9(4), 68–96. https://digitalscholarship.unlv.edu/ gender and racial health disparities. A narrowing of the glyce- jhdrp/vol10/iss1/5 5. Yano EM, Haskell S, Hayes P. Delivery of Gender-Sensitive Comprehen- mic control gap between non-Hispanic White and Black pa- sive Primary Care to Women Veterans: Implications for VA Patient Aligned tients was reported. However, the difference was insignificant Care Teams. Journal of General Internal Medicine, 29(2): S703–707. with the introduction of gender into the model, which may be https://doi.org/10.1007/s11606-013-2699-3 due to heterogeneity of female primary care delivery within the VA system . Although PCMH/PACT adoption has Published online June 4, 2018

Journal

Journal of General Internal MedicineSpringer Journals

Published: Jun 4, 2018

References

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