Intensive Outpatient Program Effects on High-need Patients’ Access, Continuity, Coordination, and Engagement

• Published in: Medical care 2018-01, Vol.56 (1), p.19-24
• Main Authors: Wu, Frances M, Slightam, Cindie A, Wong, Ava C, Asch, Steven M, Zulman, Donna M
• Format: Article
• Language: English
• Subjects: Chronic illnesses; Disability; Effects; Health care; Health care access; Management; Outpatient care facilities; Patients; Primary care
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000833

OBJECTIVE:The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patients’ care processes. RESEARCH DESIGN:Retrospective analysis using differences-in-differences and χ tests. SUBJECTS:Of 545 high-need patients receiving PCMH care, 140 were previously randomly selected for the intensive outpatient management program; the remaining received usual care. MEASURES:We evaluated program effects on care continuity (proportion of primary care visits with assigned primary care physician); access (proportion of telephone visits out of all primary care encounters, missed appointment rate); care coordination (rate of follow-up after hospital discharge, new telehealth enrollment); and patient engagement (rates of online personal health record registration, advance directive completion). RESULTS:Compared with patients receiving usual care, patients enrolled in intensive management experienced a 5.9% increase in proportion of primary care visits with an assigned primary care physician (P