Impact of the Medical Home Model on the Quality of Primary Care The Belgian Experience

• Published in: Medical care Vol. 53; no. 5; pp. 396 - 400
• Main Authors: Moureaux, Catherine, Perelman, Julian, da Costa, Elise Mendes, Roch, Isabelle, Annemans, Lieven, Heymans, Isabelle, Closon, Marie-Christine
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-05-2015; Copyright Wolters Kluwer Health, Inc. All rights reserved; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Belgium; Brief Report; Child; Child, Preschool; Clinical medicine; Cost reduction; Diabetes Mellitus - diagnosis; Diabetes Mellitus - therapy; Early Detection of Cancer - statistics & numerical data; Evidence-based medicine; Female; Guideline Adherence - statistics & numerical data; Health services utilization; Home health care; Humans; Infant; Influenza Vaccines - administration & dosage; Insurance Claim Review; Male; Middle Aged; Patient-Centered Care - organization & administration; Patient-Centered Care - statistics & numerical data; Practice Guidelines as Topic; Primary care; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data; Quality of care; Quality of Health Care - organization & administration; Retrospective Studies; Young Adult; Belgium
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000347

BACKGROUND:The Belgium medical home (MH) model, which has been garnering support of late, resembles its US counterpart in that it aims at improving the quality of health care while containing costs.
OBJECTIVES:To compare the quality of care offered by MHs with that offered by traditional individual practices (IPs) in Belgium in terms of the extent of their adherence to clinical practice guidelines in antibiotherapy, cervical-cancer screening, influenza vaccination, and the management of diabetes.
RESEARCH DESIGN:This is a retrospective study using public insurance claims data. Data consisted of a random sample of patients using the services of MHs and IPs who were previously matched according to sex, age category, location, disability, and socioeconomic status. We applied the McNemar test, the t test, or the Wilcoxon test, depending on the type of variable being compared.
SUBJECTS:The final sample comprised 43,678 patients in the year 2004.
MEASURES:On the basis of a review of the literature, we selected 4 themes, corresponding to 25 indicatorsantibiotherapy, cervical-cancer screening, influenza vaccination, and the management of diabetes.
RESULTS:MHs were more likely than IPs to adhere to evidence-based clinical practice guidelines. They prescribed less and more appropriate antibiotherapy, provided wider influenza-vaccination coverage for target groups, and provided a better follow-up for diabetics than did IPs. In regard to cervical-cancer screening, no significant differences were found.
CONCLUSIONS:MHs, as they combine a greater adherence to guidelines and savings in secondary care, are a cost-effective alternative to traditional IPs and therefore should be encouraged.