Patient-Centered Medical Homes and Oral Anticoagulation Therapy Initiation

• Published in: Medical care research and review Vol. 71; no. 2; pp. 174 - 191
• Main Authors: Beadles, Christopher A., Hassmiller Lich, Kristen, Viera, Anthony J., Greene, Sandra B., Brookhart, M. Alan, Weinberger, Morris
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2014; SAGE PUBLICATIONS, INC
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Comparative analysis; Drug therapy; Evidence based; Health insurance; Home health care; Humans; Initiation; Middle Aged; Morbidity-Mortality; North Carolina - epidemiology; Patient centredness; Patient-Centered Care - organization & administration; Quality of care; Retrospective Studies; Stroke; Young Adult; North Carolina; United States > US; atrial fibrillation; patient-centered care; guideline adherence; anticoagulation
• ISSN: 1077-5587; 1552-6801
• DOI: 10.1177/1077558713510563

Despite evidence-based guidelines, oral anticoagulation therapy (OAT) initiation is low among incident atrial fibrillation (AF) patients. Patient-centered medical homes (PCMHs) may increase access, quality, and value through coordinating care. As such, PCMHs hold potential for improving OAT initiation among AF patients. We estimated the effect of receiving care in accredited PCMHs on OAT initiation for incident AF patients compared with those not receiving care in accredited PCMHs. Our study, a retrospective cohort new user design, included privately insured patients in North Carolina during years 2006 to 2010. We developed propensity scores for PCMH exposure, performed inverse probability of treatment weighting, and estimated effects with generalized estimating equations. We found a positive association between PCMH exposure and OAT initiation in unadjusted (6.78%; p < .001) and adjusted (6.25%; p < .001) models. Greater implementation and optimization of PCMH model principles may enhance this association, reducing AF-related stroke morbidity and mortality.