title: Early changes in VA medical home components and utilization.
abstract: OBJECTIVE
  In 2010, the Veterans Health Administration (VA) began national implementation of its patient-centered medical home (PCMH) model, called Patient Aligned Care Teams (PACTs), to improve access, coordination, and patient-centered care. We evaluated changes in reported implementation of PCMH components in all VA primary care clinics, and patients' utilization of acute and non-acute care and total costs after 2 years.
  
  
  METHODS
  Longitudinal study of 2,607,902 patients from 796 VA primary care clinics.
  
  
  METHODS
  Clinics were surveyed for their implementation of PCMH components. Patient outcomes were measured by outpatient visits for primary care, specialty care, telephone care, and emergency department (ED) care; hospitalizations for an ambulatory care-sensitive condition (ACSC); and costs of VA care in fiscal years (FYs) 2009 and 2011. Multi-level, multivariable models predicted changes in utilization and costs, adjusting for patients' health status, clinic PCMH component scores, and a patient fixed effect.
  
  
  RESULTS
  Clinics reported large improvements in adoption of all PCMH components from FY 2009 to FY 2011. Higher organization of practice scores was associated with fewer primary care visits (P = .012). Greater care coordination/transitions was modestly associated with more specialty care visits (P = .010) and fewer ED visits (P = .018), but quality/performance improvement was associated with more ED visits (P = .032). None of the PCMH components were significantly related to telephone visits, ACSC hospitalizations, or total healthcare costs.
  
  
  CONCLUSIONS
  Improvements under organization of practice and care coordination/transitions appear to have impacted outpatient care, but reductions in acute care were largely absent.
authors.affiliation: 795 Willow Rd (152 MPD), Menlo Park, CA 94025. E-mail: jean.yoon@va.gov.
authors.forename: Jean
authors.initials: J
authors.lastname: Yoon
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Jeanie
authors.initials: J
authors.lastname: Lo
authors.forename: Gordon
authors.initials: G
authors.lastname: Schectman
authors.forename: Richard
authors.initials: R
authors.lastname: Stark
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement; D014481:United States; D014493:United States Department of Veterans Affairs