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New Research Unveils Previously Unknown Medical Home Benefit
Patient Access to Core Attributes of Primary Care Linked to Lower Mortality
By Sheri Porter
According to the study's researchers, their findings "advance the primary care evidence base and suggest that ongoing health care and primary care practice redesign efforts in the United States may have the potential to reduce preventable deaths."
In an interview with AAFP News Now, corresponding author Anthony Jerant, M.D., in the Department of Family and Community Medicine, Center for Healthcare Policy and Research at the University of California Davis in Sacramento, took that sentiment even further.
- New research shows that enhanced patient access to comprehensive, patient-centered care reduces patient mortality.
- Researchers linked existing data from Medical Expenditure Panel Surveys with data from the National Death Index.
- Racial and ethnic minorities, poorer and less-educated individuals and those lacking health insurance reported lower access to health care services with medical home attributes.
"To help avoid similar backlash against the medical home concept, we need to make sure that claims regarding its potential effects on health outcomes are grounded in research evidence as much as possible," he said.
Study Stands Alone
In this most recent study, researchers looked at how patients reported on whether their doctors offered attributes that are considered core indicators of good primary care, and then assessed whether reported access to those attributes were associated with lower mortality.
"Nobody has ever done this at a national level," said Jerant.
"Relatively few people have recognized the ability to link the Medical Expenditure Panel Survey (MEPS) data with the mortality data found in the National Death Index, (NDI)" as we did," said Jerant, giving credit to Peter Franks, M.D., senior author on the paper, for realizing that it could be done and for having the expertise to manage the data.
- provided care for new health problems, preventive care, and/or referrals to other health care professionals;
- offered enhanced access via evening and weekend hours; and
- were patient-centered, meaning the physician or health care professional listened to the patients' concerns and sought their advice when choosing between treatments.
Mortality was assessed using the NDI through the end of December 2006.
"To the extent that primary care is comprehensive, patient-centered care and available to patients when needed, patients may be more likely to receive the timely preventive, acute and chronic care that has been shown to reduce mortality," said the authors. "Increased access to these attributes might also minimize unnecessary and potentially harmful care, thereby mitigating iatrogenic mortality," they added.
Authors called this disturbing "in light of health disparities disfavoring these groups," and suggested interventions to promote equitable access to health care professionals who can provide the primary care medical home attributes measured in the study.
In addition, researchers said they found evidence of "geographic variation" with regard to patient access to health care professionals who offered the medical home attributes and suggested a move toward ensuring uniform dissemination across all regions of the United States.
Jerant concluded that there was much work yet to be done.
"I would like to see other researchers replicate and expand on our findings," he said. "For example, we now need to study the potential mortality impact of other medical home attributes -- such as team-oriented care -- for which we had no measures in our data set."
Jerant said further research could show that in an even more advanced medical home setting, patients live longer and report that they feel healthier.
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