Impacts of the Patient-Centred Medical Home on Healthcare Access and Utilization Indicators For Adults With Intellectual and Developmental Disabilities in Ontario

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Date
2016-01-05
Authors
Dixon, Jeffrey
Keyword
Primary Care , Patient-Centred Medical Home , Intellectual and Developmental Disabilities , Access to Care , Health Services and Policy Research , Difference-in-Differences
Abstract
Background: This study assessed the relationship between the patient-centred medical home (PCMH), as exemplified by the Family Health Team (FHT) program in Ontario, and healthcare access and utilization by adults with intellectual and developmental disabilities (IDD) aged 18-64 years. Methods: Using administrative data from the Institute for Clinical Evaluative Sciences, a retrospective cohort was developed to compare an intervention group, patients treated through a PCMH model, the FHT, against a control of patients treated through primary care models lacking key features of PCMH care. A difference-in-differences (DiD) approach was used to estimate the effect of the PCMH model on four access indicators – uptake of the periodic health exam, and screens for breast, cervical, and colorectal cancers – and one utilization indicator – avoidable emergency department (ED) utilization rate. Results: FHT-based care reduced the proportion of patients who had an exam over three years by 4.4 percentage points (p<0.0001). It the proportion of patients who were up-to-date with colorectal cancer screens by 4.9 percentage points (p=0.0035). Breast and cervical cancer screenings also showed positive results of 2.9 and 2.4 percentage points respectively, although the results in both were not significant (p=0.214 and 0.0565, respectively). The PCMH care showed no impact on avoidable ED visits. Models were tested for potential confounders including patient demographics, comorbidities, physician demographics, and practice characteristics. In all five tests, the DiD estimator remained relatively constant between simple models and full models which adjusted for confounding variables, suggesting that the models are robust. Conclusions: The results show the complexity of evaluating the impacts of primary care models. The positive trends in cancer screening uptake under PCMH care suggests that with proper incentives PCMH does have a positive impact on access to care by adults with IDD. The negative impact on periodic health exam uptake highlights the need for a tool specific to this population’s needs to ensure guidelines are met. Future research should assess PCMH care against a broader range of healthcare utilization indicators and advance this study’s identification of relevant covariates including complex comorbidities and the effects of physician and practice characteristics on healthcare access and utilization.
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