Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1067 — Association of the Office of Academic Affiliations' Centers of Excellence in Primary Care Education with Quality of Care and Utilization

Lead/Presenter: Samuel Edwards, COIN - Portland
All Authors: Edwards ST (VA Portland) Kim H (Oregon Health & Science University) Forsberg C (VA Portland) Shull S (VA Portland) Harada N (Office of Academic Affiliations) Tuepker A (VA Portland)

Objectives:
Interprofessional Education (IPE) is often cited as a way to improve the practice of primary care, but the effect of IPE interventions on patient outcomes is unknown. In 2011, the Office of Academic Affiliations launched the Centers of Excellence for Primary Care Education (CoEPCE) at five Medical Centers to integrate the clinical training of resident physicians and nurse practitioner students and residents in primary care. We examined the impact of this initiative on clinical quality and utilization.

Methods:
We performed a cohort study of primary care patients seen in the five CoEPCE sites over the four years before and after initiative launch (7/1/2007-6/30/2015). Intervention patients were defined as those assigned to a CoEPCE team and having a trainee primary care provider (PCP) while control patients were those assigned to non-CoEPCE teams and staff PCPs. Outcomes included diabetes mellitus (DM) care quality (hemoglobin A1c [HbA1c] performed, HbA1c poor control, Renal Testing), inappropriate prescribing in elderly patients, timely mental health referrals, integrated primary care mental health (PCMHI) visits, primary care visits, emergency department (ED) visits and hospitalizations. We used difference-in-differences models, to compare changes in outcomes in intervention patients after CoEPCE implementation to changes in outcomes in control patients. Models controlled for patient age, sex, race, Elixhauser comorbidities, and CoEPCE site.

Results:
Among 59,727 patients, 8,277 were assigned to the CoEPCE. The likelihood of a timely mental health referral increased among COEPCE patients by 2.1% (95% CI: 0.1-4.1, p = 0.04), a 12% increase from the pre-COEPCE mean (17.6 per patient-year). Similarly, the likelihood of a PCMHI visits increased by 1.9% (95% CI: 0.6-3.2, p = 0.02) per patient year, a 23% increase from the pre-CoEPCE mean (8.3%). The likelihood of poor A1c control declined by 2.5% among CoEPCE patients (95% CI: -0.02-5.0, p = 0.05), a decrease of 9.5% from the pre-CoEPCE mean (26.3%). There were no changes in HbA1c performed, renal testing for DM, inappropriate prescribing in elderly patients, primary care visits, ED visits or hospitalizations.

Implications:
The CoEPCE were associated with improvements in diabetes control, increased rates of timely mental health referrals and integrated primary care mental health visits, but was not associated with changes in other quality measures or utilization.

Impacts:
Interprofessional education in VA primary care was associated with improved quality and utilization for some measures.