Primary Care Delivery by Associate Care Providers in the Patient Centered Medical Home.
dc.contributor.author | Annis, Ann Marie | en_US |
dc.date.accessioned | 2016-01-13T18:05:13Z | |
dc.date.available | NO_RESTRICTION | en_US |
dc.date.available | 2016-01-13T18:05:13Z | |
dc.date.issued | 2015 | en_US |
dc.date.submitted | 2015 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/116732 | |
dc.description.abstract | INTRODUCTION: The Patient Centered Medical Home (PCMH) requires collaboration and task delegation among primary care providers (PCPs: physicians, nurse practitioners, physician assistants, and medical residents) and associate care providers (ACPs: nurses, pharmacists, social workers, dietitians, and behavioral health providers). Within PCMH, ACPs have expanded roles in clinical care delivery. However, PCMH evaluations have primarily focused on the performance of PCPs. AIMS: 1) To assess the extent to which PCMH measures encompass ACP-delivered care; 2) To determine trends in care delivery across different types of providers before and during PCMH implementation; and 3) To examine relationships between PCMH implementation, ACP care delivery, and resource utilization. METHODS: Study 1 was a systematic literature review of PCMH access and care coordination measures to assess their inclusion of ACP-delivered care. Study 2 analyzed five years of retrospective, in-person, clinical patient encounters by PCPs and ACPs among 764 Veterans Health Administration (VHA) primary care sites. Negative binomial regression estimated monthly rates of provider-delivered encounters among sites before and during PCMH implementation. Study 3 was a cross-sectional analysis of VHA primary care sites during two twelve-month periods, before (n=688) and during (n=684) PCMH implementation. Structural equation modeling tested whether the rate of nurse-delivered encounters mediated the effect of PCMH implementation on inpatient hospitalization. RESULTS: Review of 42 PCMH studies found wide variability in the inclusion of ACP care in measurement approaches, and limited information about ACP impact on outcomes. Study 2 showed that ACPs delivered 29% of in-person encounters in fiscal year (FY) 2009 (pre-PCMH), and 35% in FY2013 (during PCMH implementation). Monthly rates of PCP encounters decreased, while those for some ACPs increased during PCMH implementation. Mediation analyses demonstrated a significant positive relationship between the level of PCMH implementation and the rate of nurse-delivered encounters, and a significant negative relationship between nurse-delivered encounters and the rate of hospitalizations during PCMH. CONCLUSIONS: Findings suggest that a shift in care delivery from PCPs to some ACPs occurred in VHA primary care sites after the introduction of PCMH. ACP-delivered care may be an important mechanism of how PCMH impacts outcomes and should be included in PCMH evaluations. | en_US |
dc.language.iso | en_US | en_US |
dc.subject | Primary care delivery by associate care providers in the patient centered medical home | en_US |
dc.title | Primary Care Delivery by Associate Care Providers in the Patient Centered Medical Home. | en_US |
dc.type | Thesis | en_US |
dc.description.thesisdegreename | PhD | en_US |
dc.description.thesisdegreediscipline | Nursing | en_US |
dc.description.thesisdegreegrantor | University of Michigan, Horace H. Rackham School of Graduate Studies | en_US |
dc.contributor.committeemember | Harris, Marcelline Ruth | en_US |
dc.contributor.committeemember | Lee, Shoou-Yih Daniel | en_US |
dc.contributor.committeemember | Krein, Sarah L | en_US |
dc.contributor.committeemember | Kim, Hyungjin Myra | en_US |
dc.contributor.committeemember | Redman, Richard W | en_US |
dc.subject.hlbsecondlevel | Family Medicine and Primary Care | en_US |
dc.subject.hlbsecondlevel | Nursing | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/116732/1/aannis_1.pdf | |
dc.owningcollname | Dissertations and Theses (Ph.D. and Master's) |
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