title: Outcomes among chronically ill adults in a medical home prototype.
abstract: OBJECTIVE
  To compare quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites.
  
  
  METHODS
  Nonequivalent pretest-posttest control group design.
  
  
  METHODS
  PCMH redesign results were investigated for patients with preexisting diabetes, hypertension, and/or coronary heart disease. Data from automated databases were collected for eligible enrollees in an integrated healthcare delivery system. Multivariable regression models tested for adjusted differences between PCMH patients and controls during the baseline and follow-up periods. Dependent measures under study included clinical processes and, outcomes, monthly healthcare utilization, and costs.
  
  
  RESULTS
  Compared with controls over 2 years, patients at the PCMH prototype clinic had slightly better clinical outcome control in coronary heart disease (2.20 mg/dL lower mean low-density lipoprotein cholesterol; P <.001). PCMH patients changed their patterns of primary care utilization, as reflected by 86% more secure electronic message contacts (P <.001), 10% more telephone contacts (P = .003), and 6% fewer in-person primary care visits (P <.001). PCMH patients had 21% fewer ambulatory care-sensitive hospitalizations (P <.001) and 7% fewer total inpatient admissions (P = .002) than controls. During the 2-year redesign, we observed 17% lower inpatient costs (P <.001) and 7% lower total healthcare costs (P <.001) among patients at the PCMH prototype clinic.
  
  
  CONCLUSIONS
  A clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Dr, 10th Fl, Chicago, IL 60611. E-mail: david.liss@northwestern.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Ross
authors.forename: Eric A
authors.initials: EA
authors.lastname: Johnson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D006679:HIV Seropositivity / Q000175:diagnosis; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012044:Regression Analysis; D055815:Young Adult