title: Managing drug-related morbidity and mortality in the patient-centered medical home.
abstract: BACKGROUND
  The appropriate use of medications can influence quality performance measures and costs. Drug-related morbidity and mortality represents a public health challenge due to the ineffective and unsafe consequences of medication use. This article addresses the impact of team-based care that incorporates comprehensive medication therapy management on per capita expenditures, quality performance measures, and resolution of drug therapy problems.
  
  
  METHODS
  A team-based medication therapy management system developed over 13 years in an integrated health system in 4 Minnesota innovation clinic sites was assessed in terms of: (1) differences in total median health expenditures compared with noninnovation clinics, (2) improvements on 5 performance benchmarks for patients with diabetes in comparison with statewide results, and (3) resolution of drug therapy problems.
  
  
  RESULTS
  Spending growth was 11% less in innovation clinics than that in 38 noninnovation clinics. Median per member per month health care costs measured at 5 intervals over a 15-month period were significantly lower in innovation than in noninnovation sites (P=0.05). Forty percent of patients with diabetes in the innovation clinics achieved all 5 performance benchmark treatment goals in 2009, with a range from 34% to 45%, compared with the statewide result of 17.5% of patients achieving all 5 benchmarks. In addition, over 4000 drug therapy problems were reported to be resolved.
  
  
  CONCLUSIONS
  Team-based care helped to achieve quality performance and control spending growth through medication therapy management in a patient-centered medical home innovation.
authors.affiliation: Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, 308 Harvard Street, SE, Weaver-Densford Hall, Room 7-125c, Minneapolis, MN 55455, USA. isett001@umn.edu
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Isetts
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Brummel
authors.forename: Djenane Ramalho
authors.initials: DR
authors.lastname: de Oliveira
authors.forename: David W
authors.initials: DW
authors.lastname: Moen
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000628:therapy; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D054539:Medication Therapy Management / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D009017:Morbidity; D009026:Mortality; D010348:Patient Care Team / Q000458:organization & administration; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration / Q000706:statistics & numerical data