Volume 49 | Number 1 | February 2014

Abstract List

Michael L. Paustian Ph.D., Jeffrey A. Alexander Ph.D., Darline K. El Reda, Chris G. Wise, Lee A. Green M.D., M.P.H., Michael D. Fetters


To examine the associations between partial and incremental implementation of the Patient Centered Medical Home () model and measures of cost and quality of care.

Data Source

We combined validated, self‐reported capabilities data with administrative claims data for a diverse statewide population of 2,432 primary care practices in ichigan. These data were supplemented with contextual data from the Area Resource File.

Study Design

We measured medical home capabilities in place as of une 2009 and change in medical home capabilities implemented between uly 2009 and une 2010. Generalized estimating equations were used to estimate the mean effect of these measures on total medical costs and quality of care delivered in physician practices between uly 2009 and une 2010, while controlling for potential practice, patient cohort, physician organization, and practice environment confounders.

Principal Findings

Based on the observed relationships for partial implementation, full implementation of the model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.


Estimated effects of the model on quality and cost of care appear to improve with the degree of implementation achieved and with incremental improvements in implementation.