title: Medical home transformation and breast cancer screening.
abstract: OBJECTIVE
  The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service.
  
  
  METHODS
  Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts.
  
  
  METHODS
  Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements. We included women aged 50 to 74 years who had at least 1 primary care visit at a participating clinic between April 2012 and December 2013 (n = 20,349)-a period of medical home transformation. The main measures included: a) whether screening was up-to-date at the time of the visit (mammography completion within 24 months prior to the visit); and b) if screening was overdue at the visit (ie, it had been more than 24 months since the last mammogram), and whether timely screening was completed within 3 months after the visit.
  
  
  RESULTS
  In adjusted analyses, PCMH transformation scores were negatively associated with up-to-date screening status (odds ratio [OR] for a 20-point change, 0.93; 95% confidence interval [CI], 0.89-0.96) and with timely screening of women who were overdue (OR, 0.94; 95% CI, 0.87-1.02).
  
  
  CONCLUSIONS
  Preventative care, such as breast cancer screening, may not improve in early PCMH implementation.
authors.forename: Amy W
authors.initials: AW
authors.lastname: Baughman
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Qianfei
authors.initials: Q
authors.lastname: Wang
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Brigham and Women's Hospital, 1620 Tremont St, 3rd Fl, Boston, MA 02120. E-mail: Jhaas@partners.org.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008329:Managed Care Programs / Q000458:organization & administration; D008404:Massachusetts; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment