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Patient-centered medical home implementation and primary care provider turnover.
Med Care. 2014 Dec; 52(12):1017-22.MC

Abstract

BACKGROUND

The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH implementation and PCP turnover.

METHODS

This was a retrospective, longitudinal study of VHA-employed PCPs spanning 29 calendar quarters before PACT and eight quarters of PACT implementation. PCP employment periods were identified from administrative data and turnover was defined by an indicator on the last quarter of each uncensored period. An interrupted time series model was used to estimate the association between PACT and turnover, adjusting for secular trend and seasonality, provider and job characteristics, and local unemployment. We calculated average marginal effects (AME), which reflected the change in turnover probability associated with PACT implementation.

RESULTS

The quarterly rate of PCP turnover was 3.06% before PACT and 3.38% after initiation of PACT. In adjusted analysis, PACT was associated with a modest increase in turnover (AME=4.0 additional PCPs per 1000 PCPs per quarter, P=0.004). Models with interaction terms suggested that the PACT-related change in turnover was increasing in provider age and experience.

CONCLUSIONS

PACT was associated with a modest increase in PCP turnover, concentrated among older and more experienced providers, during initial implementation. Our findings suggest that policymakers should evaluate potential workforce effects when implementing PCMH.

Authors+Show Affiliations

*Northwest HSR&D Center for Innovation, VA Puget Sound Healthcare System †Department of Health Services, School of Public Health, University of Washington ‡General Internal Medicine Service, VA Puget Sound Healthcare System §Department of Medicine, School of Medicine, University of Washington ∥VHA Office of Analytics and Business Intelligence, VA Puget Sound Healthcare System, Seattle, WA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

25271536

Citation

Sylling, Philip W., et al. "Patient-centered Medical Home Implementation and Primary Care Provider Turnover." Medical Care, vol. 52, no. 12, 2014, pp. 1017-22.
Sylling PW, Wong ES, Liu CF, et al. Patient-centered medical home implementation and primary care provider turnover. Med Care. 2014;52(12):1017-22.
Sylling, P. W., Wong, E. S., Liu, C. F., Hernandez, S. E., Batten, A. J., Helfrich, C. D., Nelson, K., Fihn, S. D., & Hebert, P. L. (2014). Patient-centered medical home implementation and primary care provider turnover. Medical Care, 52(12), 1017-22. https://doi.org/10.1097/MLR.0000000000000230
Sylling PW, et al. Patient-centered Medical Home Implementation and Primary Care Provider Turnover. Med Care. 2014;52(12):1017-22. PubMed PMID: 25271536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-centered medical home implementation and primary care provider turnover. AU - Sylling,Philip W, AU - Wong,Edwin S, AU - Liu,Chuan-Fen, AU - Hernandez,Susan E, AU - Batten,Adam J, AU - Helfrich,Christian D, AU - Nelson,Karin, AU - Fihn,Stephan D, AU - Hebert,Paul L, PY - 2014/10/2/entrez PY - 2014/10/2/pubmed PY - 2015/2/24/medline SP - 1017 EP - 22 JF - Medical care JO - Med Care VL - 52 IS - 12 N2 - BACKGROUND: The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH implementation and PCP turnover. METHODS: This was a retrospective, longitudinal study of VHA-employed PCPs spanning 29 calendar quarters before PACT and eight quarters of PACT implementation. PCP employment periods were identified from administrative data and turnover was defined by an indicator on the last quarter of each uncensored period. An interrupted time series model was used to estimate the association between PACT and turnover, adjusting for secular trend and seasonality, provider and job characteristics, and local unemployment. We calculated average marginal effects (AME), which reflected the change in turnover probability associated with PACT implementation. RESULTS: The quarterly rate of PCP turnover was 3.06% before PACT and 3.38% after initiation of PACT. In adjusted analysis, PACT was associated with a modest increase in turnover (AME=4.0 additional PCPs per 1000 PCPs per quarter, P=0.004). Models with interaction terms suggested that the PACT-related change in turnover was increasing in provider age and experience. CONCLUSIONS: PACT was associated with a modest increase in PCP turnover, concentrated among older and more experienced providers, during initial implementation. Our findings suggest that policymakers should evaluate potential workforce effects when implementing PCMH. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/25271536/Patient_centered_medical_home_implementation_and_primary_care_provider_turnover_ DB - PRIME DP - Unbound Medicine ER -