title: Do patient-centered medical homes reduce emergency department visits?
abstract: OBJECTIVE
  To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness.
  
  
  METHODS
  Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012.
  
  
  METHODS
  We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories.
  
  
  RESULTS
  Among chronically ill patients, transition to PCMH status was associated with 5-8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension.
  
  
  CONCLUSIONS
  Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.
authors.affiliation: The Wharton School, University of Pennsylvania, Philadelphia, PA.
authors.forename: Guy
authors.initials: G
authors.lastname: David
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
authors.forename: Philip A
authors.initials: PA
authors.lastname: Saynisch
authors.forename: Ravi
authors.initials: R
authors.lastname: Chawla
authors.forename: Somesh
authors.initials: S
authors.lastname: Nigam
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010414:Pennsylvania; D018570:Risk Assessment; D012959:Socioeconomic Factors
keywords: Patient-centered medical home; chronic illness; emergency department
references.citation: Ann Intern Med. 2003 Feb 4;138(3):244-7
references.pmid: 12558374
references.citation: Health Serv Res. 2014 Feb;49(1):52-74
references.pmid: 23829322
references.citation: Ann Intern Med. 2013 Feb 5;158(3):169-78
references.pmid: 24779044
references.citation: Med Care. 2009 Nov;47(11):1113-20
references.pmid: 19786921
references.citation: Am J Manag Care. 2009 Aug;15(8):555-9
references.pmid: 19670959
references.citation: Am J Manag Care. 2012 Feb;18(2):105-16
references.pmid: 22435838
references.citation: Ann Fam Med. 2011 Nov-Dec;9(6):515-21
references.pmid: 22084262
references.citation: JAMA. 2002 Oct 9;288(14):1775-9
references.pmid: 12365965
references.citation: N Engl J Med. 2009 Jun 25;360(26):2693-6
references.pmid: 19553643
references.citation: Health Aff (Millwood). 2013 Jan;32(1):175-83
references.pmid: 23242631
references.citation: Health Aff (Millwood). 2012 Sep;31(9):2010-7
references.pmid: 22949450
references.citation: Am J Manag Care. 2009 Sep 01;15(9):e71-87
references.pmid: 19728768
references.citation: Am J Manag Care. 2012 Sep;18(9):534-44
references.pmid: 23009304
references.citation: Med Care Res Rev. 2012 Oct;69(5):560-80
references.pmid: 22813721
references.citation: Dis Manag. 2006 Feb;9(1):45-55
references.pmid: 16466341
references.citation: JAMA. 2000 Jul 19;284(3):363-5
references.pmid: 10891969
references.citation: Health Aff (Millwood). 2010 May;29(5):835-43
references.pmid: 20439869
references.citation: Health Aff (Millwood). 2010 May;29(5):773-8
references.pmid: 20439860
references.citation: Milbank Q. 1996;74(4):511-44
references.pmid: 8941260
references.citation: Am J Manag Care. 2012 Nov;18(11):677-86
references.pmid: 23198711
references.citation: Issue Brief (Commonw Fund). 2000 Nov;(434):1-12
references.pmid: 11665699
references.citation: Pediatrics. 2004 Sep;114(3):820-6
references.pmid: 15342859
references.citation: Health Aff (Millwood). 2013 Mar;32(3):571-8
references.pmid: 23459737
references.citation: Med Care. 2013 Jun;51(6):487-93
references.pmid: 23552431
references.citation: Health Aff (Millwood). 2010 Sep;29(9):1630-6
references.pmid: 20820018
references.citation: Am J Manag Care. 2010 Aug;16(8):607-14
references.pmid: 20712394
references.citation: Diabetes Care. 2011 Apr;34(4):1047-53
references.pmid: 21447667
references.citation: Am J Manag Care. 2009 Dec;15(10 Suppl):S291-9
references.pmid: 20088633
references.citation: Med Care. 2011 Jan;49(1):10-6
references.pmid: 21079525
references.citation: N Engl J Med. 2011 Jan 27;364(4):293-5
references.pmid: 21226568
references.citation: Health Aff (Millwood). 2008 Sep-Oct;27(5):1219-30
references.pmid: 18780904