Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

作者：Kohler Racquel E; Goyal Ravi K; Lich Kristen Hassmiller; Domino Marisa Elena; Wheeler Stephanie B^*

来源：Cancer, 2015, 121(22): 3975-U30.

DOI：10.1002/cncr.29596

• breast cancer
• health care utilization
• Medicaid costs
• medical home

BACKGROUNDThe patient-centered medical home (PCMH) is increasingly being implemented in an effort to improve and coordinate primary care, but its effect on health care utilization among breast cancer patients remains unclear. The objective of this study was to examine health care utilization and expenditures as a function of PCMH enrollment among breast cancer patients in North Carolina's Medicaid program.
METHODSNorth Carolina Medicaid claims linked to North Carolina Central Cancer Registry records (2003-2007) were used to examine monthly patterns of health care use and expenditures. Controlling for a selection bias for time-invariant characteristics, fixed effects regression models analyzed associations between PCMH enrollment and utilization of outpatient, inpatient, and emergency department (ED) services and Medicaid expenditures during the 15 months after the diagnosis of breast cancer.
RESULTSAmong 758 breast cancer patients, 381 (50%) were enrolled in a PCMH at some time in the 15 months after diagnosis. After controlling for individual fixed effects, PCMH enrollment was significantly associated with greater outpatient service use, but there was no difference in the probability of inpatient hospitalizations or ED visits. Enrollment in a PCMH was associated with increased average expenditures of $429 per month during the first 15 months.
CONCLUSIONSGreater outpatient care utilization and increased average expenditures among breast cancer patients enrolled in a PCMH may suggest that these women have improved access to primary and specialty care. Expanding PCMHs may change patterns of service utilization for Medicaid breast cancer patients but may not be associated with lower costs. Cancer 2015;121:3975-3981. (c) 2015 American Cancer Society.
Medical home enrollment is associated with greater outpatient service use and increased average expenditures among breast cancer patients. This may suggest that these women are more likely to be connected to primary and specialty care during the immediate postdiagnosis period.

• 出版日期2015-11-15