Implications of reassigning patients for the medical home: a case study.
OBJECTIVE
Improving patient-doctor continuity is one goal of the medical home, but achieving this goal may require physicians to reduce panel size. This article examines the impact on patient experience and utilization of Group Health Cooperative's process of reassigning patients to new physicians as part of their medical home demonstration project.


METHODS
This work represents a subanalysis of the Group Health medical home pilot evaluation. Study participants include 8,005 adults who received primary care in 2006 and 2007 at an urban practice owned and operated by a not-for-profit integrated delivery system. Approximately one-quarter of patients were selected to be reassigned to a new physician. Primary care, emergency department, secure messaging, and telephone utilization were captured through automated sources. Patients' experience was measured before and after implementation of the medical home for a subset of 1,098 patients.


RESULTS
Patients who were retained by their existing physicians were older, sicker, and had longer preexisting patient-doctor relationships. After reassignment, reassigned patients were less likely to use primary care services but equally likely to use the emergency department. They were no less satisfied with their care experience.


CONCLUSIONS
Informational and managerial continuity may mitigate deleterious effects of reassignment, but more must be done to actively bind reassigned patients to the medical home to improve relational continuity with younger, healthier patients.
Group Health Research Institute, Seattle, WA 98101, USA. coleman.cf@ghc.org
Katie
K
Coleman
Robert J
RJ
Reid
Eric
E
Johnson
Clarissa
C
Hsu
Tyler R
TR
Ross
Paul
P
Fishman
Eric
E
Larson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D003695:Delivery of Health Care; D005260:Female; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010865:Pilot Projects; D016012:Poisson Distribution; D011795:Surveys and Questionnaires; D014861:Washington; D055815:Young Adult