title: Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study.
abstract: BACKGROUND
  Despite the widespread adoption of patient-centered medical homes into primary care practice, the evidence supporting their effect on health care outcomes has come primarily from geographically localized and well-integrated health systems.
  
  
  OBJECTIVE
  To assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Claims from a large national health insurer.
  
  
  METHODS
  Patients initiating therapy with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013.
  
  
  METHODS
  Medication adherence in the 12 months after treatment initiation was compared among patients cared for by providers practicing in National Committee for Quality Assurance-recognized patient-centered medical homes and propensity score-matched control practices in the same Primary Care Service Areas. Linear mixed models were used to examine the association between medical homes and adherence.
  
  
  RESULTS
  Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. Among 4660 matched control and medical home practices, medication adherence was significantly higher in medical homes (2.2% [95% CI, 1.5% to 2.9%]). The association between medical homes and better adherence did not differ significantly by disease state (diabetes, 3.0% [CI, 1.5% to 4.6%]; hypertension, 3.2% [CI, 2.2% to 4.2%]; hyperlipidemia, 1.5% [CI, 0.6% to 2.5%]).
  
  
  CONCLUSIONS
  Clinical outcomes related to medication adherence were not assessed.
  
  
  CONCLUSIONS
  Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases.
  
  
  BACKGROUND
  CVS Health.
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lauffenburger
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Franklin
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Krumme
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Olga S
authors.initials: OS
authors.lastname: Matlin
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Pezalla
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Spettell
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Gregory
authors.initials: G
authors.lastname: Brill
authors.affiliation: From Brigham and Women's Hospital, Ariadne Labs, Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston, Massachusetts; CVS Health, Woonsocket, Rhode Island; and Aetna, Hartford, Connecticut.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies