title: Patient-centered medical homes and oral anticoagulation therapy initiation.
abstract: Despite evidence-based guidelines, oral anticoagulation therapy (OAT) initiation is low among incident atrial fibrillation (AF) patients. Patient-centered medical homes (PCMHs) may increase access, quality, and value through coordinating care. As such, PCMHs hold potential for improving OAT initiation among AF patients. We estimated the effect of receiving care in accredited PCMHs on OAT initiation for incident AF patients compared with those not receiving care in accredited PCMHs. Our study, a retrospective cohort new user design, included privately insured patients in North Carolina during years 2006 to 2010. We developed propensity scores for PCMH exposure, performed inverse probability of treatment weighting, and estimated effects with generalized estimating equations. We found a positive association between PCMH exposure and OAT initiation in unadjusted (6.78%; p < .001) and adjusted (6.25%; p < .001) models. Greater implementation and optimization of PCMH model principles may enhance this association, reducing AF-related stroke morbidity and mortality.
authors.affiliation: 1Center for Health Services Research in Primary Care, Durham, VA, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.forename: Kristen
authors.initials: K
authors.lastname: Hassmiller Lich
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Greene
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D018802:Patient-Centered Care / Q000458:organization & administration; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; atrial fibrillation; guideline adherence; patient-centered care