Funded Projects

(SDAS) Analysis of Medical Home Characteristics and Asthma Control Using SAFTINet Data

Grantee: University of Colorado
Principal Investigator: Marion R Sills
Project Number: R40MC26813
Project Date: 04/01/2014

Age group(s)

• Early Childhood (3-5 years)
• Middle Childhood (6-11 years)
• Adolescence (12-18 years)

Abstract

The Patient-Centered Medical Home (PCMH) model has been widely endorsed and is the focus of multiple efforts to reform primary care delivery. Despite this, evidence about the effectiveness of the PCMH model is inconclusive. Given the substantial investment required to proceed with broad adoption of the PCMH model, many decision makers are demanding a solution to this research gap, namely, rigorous evidence about the effectiveness of the PCMH model. We propose measuring the PCMH model's effectiveness in a population of children with asthma because asthma is common, is costly, and is a condition amenable to appropriate monitoring and management in primary care settings, and thus is a condition likely to demonstrate the effects of PCMH characteristics. We propose a secondary analysis of electronic data generated in the course of routine clinical care at four health care organizations participating in the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet), a federally-funded practice-based distributed research network designed precisely for measuring health care delivery system characteristics-specifically, the PCMH model and disease outcomes with minimal burden on clinical practices. Practice-level PCMH characteristics will be correlated with patient-level asthma outcomes, controlling for potential confounding variables, using a clustered design. We will assess patient-level asthma outcomes in 2 ways: exacerbations and patient-reported asthma control. Linear and non-linear mixed models will be used for analysis. Our objective is to test the hypothesis that PCMH characteristics improve the quality of care delivered to children, through estimating the effects of PCMH characteristics on asthma control in children. We expect to find that improved concordance with the PCMH model-using general PCMH, domain-specific, and asthma-specific measures-is associated with improved asthma outcomes. Our proposed approach to addressing this research problem is most directly related to Maternal and Child Health Bureau Strategic Research Issues #3: Services and systems to assure quality of care for MCH populations. Specifically, the "services and systems" we propose evaluating are those related to the PCMH. The quality domain we propose to focus on is the effectiveness of asthma care delivery.