Do experiences consistent with a medical-home model improve diabetes care measures reported by adult medicaid patients?

Abstract

OBJECTIVE: The patient-centered medical home has gained much traction. Little is known about the relationship between the model and specific health care processes for chronic diseases such as diabetes. This study assesses the impact of features of a medical home on diabetes care. RESEARCH DESIGN AND METHODS A cross-sectional survey of 540 patients with Medicaid (Medi-Cal) health insurance and type 2 diabetes in Los Angeles County was performed. The Primary Care Assessment Tools was used to measure seven features of medical-home performance. RESULTS: The response rate of the patient survey was 68.9%. Patient-reported medicalhome performance averaged a score of 2.85 ± 0.29 (on a 1-4 scale, with 4 equaling the best care). Patientswho receivedmore timely and thorough diabetes care reported higher medical-home performance in every feature except for the comprehensiveness-services available. For example, the first-contact access feature score was higher among patients who had an HbA1c test in the past 6 months versus those who did not (2.38 vs. 2.25; P < 0.05). Before and after adjusting for sociodemographics and health status, total medical-home performance was positively associated with each diabetes care measure. A 1-point increase in total medical-home score was associated with 4.53 higher odds of an HbA1c test in the past 6 months and 1.88 higher odds of an eye exam in the past year. CONCLUSIONS: Features consistent with higher medical-home performance are associated with improvements in patient-reported diabetes care process measures, even in this lowsocioeconomic status setting. The patient-centered medical-homemodelmay help in caring for people with type 2 diabetes. © 2014 by the American Diabetes Association.