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Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration.

Woodard LD, Adepoju OE, Amspoker AB, Virani SS, Ramsey DJ, Petersen LA, Jones LA, Kiefer L, Mehta P, Naik AD. Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration. Journal of general internal medicine. 2018 Aug 1; 33(8):1276-1282.

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BACKGROUND: Given its widespread dissemination across primary care, the Veterans Health Administration (VA) is an ideal setting to examine the impact of the patient-centered medical home (PCMH) on diabetes outcomes. OBJECTIVE: To assess the impact of PCMH implementation on diabetes outcomes among patients receiving care in the Veterans Health Administration. DESIGN: Retrospective cohort analysis and multilevel logistic regression. PATIENTS: Twenty thousand eight hundred fifty-eight patients in one Midwest VA network who had a diabetes diagnosis in both 2009 and 2012 and who received primary care between October 1, 2008 and September 30, 2009. MAIN MEASURES: Glycemic and lipid control using VA quality indicators [hemoglobin (Hb) A1c < 9%, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL]. KEY RESULTS: Odds of glycemic control were lower in 2012 than 2009 (OR? = 0.72, 95% CI? = 0.67-0.77, p ? < 0.001), and this change in control over time varied by race (OR of the interaction between time and race? = 1.18, 95% CI? = 1.02-1.36, p ? = 0.028). While the disparity in glycemic control between white and black patients persisted post-PCMH, the magnitude of the disparity was smaller in 2012 compared to 2009 (2012: OR? = 1.32, 95% CI? = 1.18-1.47, p ? < 0.0001 and 2009: OR? = 1.59, 95% CI? = 1.39-1.82, p ? < 0.0001). Odds of lipid control did not significantly change between 2009 and 2012 and change did not vary by race and/or gender. CONCLUSIONS: Although there were no significant improvements in odds of lipid control, and odds of glycemic control decreased following PCMH implementation, there was evidence of reduced racial disparities in glycemic control post-PCMH implementation.

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