3025 — Medical Home Readiness of VA Primary Care Clinics and Avoidable Hospitalizations
Yoon J, Palo Alto VA; Rose D, and Canelo I, Greater Los Angeles VA; Upadhyay A, Palo Alto VA; Stark R, and Schectman G, VACO; Rubenstein L, and Yano E, Greater Los Angeles VA;
The VHA’s Patient Aligned Care Team (PACT) initiative focuses on improving ambulatory care while reducing unnecessary acute care. We examined whether higher medical home readiness of primary care clinics at baseline was associated with lower rates of avoidable hospitalizations.
We obtained a cohort of 2,853,030 patients who visited 814 VA primary care clinics in the baseline study year (FY09) and linked patient and clinic data. Our outcome measure, hospitalizations for an ambulatory care sensitive condition, was measured in the follow-up year (FY10) and identified from VA and Fee Basis inpatient records. Medical home readiness of clinics came from a 2009 survey of all VA primary care clinics covering seven components: Patient-Centered Care and Communication, Access/Scheduling, Organization of Practice, Coordination/Transitions in Care, Use of Technology, Population Management, and Quality Improvement/Performance Improvement. Bivariate analyses compared rates of ACSC admissions by medical home readiness using a one-way ANOVA. Multivariate analyses estimated the effect of overall and component scores of medical home readiness on risk for ACSC admission in logistic regression models adjusting for all baseline patient (e.g. age, comorbidity, distance to clinic) and clinic factors (VAMC vs. CBOC, size, rurality) and adjusting standard errors for clustering within clinic.
In the study clinics, the medical home readiness score mean was 88 (SD = 13). In unadjusted analyses, patients in the highest (>90) and lowest (<81) scoring clinics on medical home readiness had a rate of 20 and 25 ACSC admissions per 1,000 patients, respectively (P <0.0001). In adjusted analyses patients in clinics with highest medical home readiness had significantly lower risk of an ACSC hospitalization than patients in clinics with the lowest scores (OR = 0.90, P = 0.014). When examining separate components of medical home readiness, patients in clinics with higher access and scheduling (P = 0.017), coordination (P = 0.007), and quality improvement (P = 0.046) scores had significantly lower risk of an ACSC hospitalization in adjusted analyses.
Medical home readiness of VA primary care clinics was significantly associated with avoidable hospitalizations.
Access, coordination, and quality improvement components may be important elements in building medical homes in VA primary care clinics that can improve outcomes of care.