The Medical Home Initiative in Italy: an Analysis of Changes in Healthcare Utilization

• Published in: Journal of general internal medicine : JGIM Vol. 37; no. 6; pp. 1380 - 1387
• Main Authors: Keith, Scott W., Waters, Dexter, Alcusky, Matthew, Hegarty, Sarah, Jafari, Niusha, Lombardi, Marco, Pini, Monica, Maio, Vittorio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2022; Springer Nature B.V
• Subjects: Ambulatory care; Chronic obstructive pulmonary disease; Congestive heart failure; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Health care; Health services utilization; Hospitalization; Humans; Internal Medicine; Longitudinal Studies; Lung diseases; Medicine; Medicine & Public Health; Obstructive lung disease; Original Research; Patient Acceptance of Health Care; Patient admissions; Patient-Centered Care; Primary care; Pulmonary Disease, Chronic Obstructive; Risk; Utilization; Italy; Italy; medical homes; healthcare utilization; hospitalization; readmission; emergency department visits
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-021-07040-9

Background
Seventeen medical homes (MHs) were established in the Local Health Authority (LHA) of Parma (about 450,000 residents), Emilia Romagna, Italy, between 2011 and 2016.
Objective
To estimate the effects of MH implementation on healthcare utilization.
Design
We conducted a longitudinal cohort study (01/2011–12/2017) using the Parma LHA administrative healthcare database.
Participants
Residents for ≥1 year and older than 14 years of age with a documented primary care physician (PCP) in Parma LHA.
Intervention
MH exposure status was classified for each resident as either receiving care from a PCP that (1) eventually practices in an MH (pre-MH), (2) is currently in an MH (post-MH), or (3) does not join an MH (non-MH).
Main Outcome Measures
Risks of ordinary inpatient hospital admissions, day hospital admissions, admissions for ambulatory care sensitive conditions (ACSCs), all-cause emergency department (ED) visits, and deferrable ED visits were compared using Cox proportional hazards regression and risks of all-cause 30- and 90-day readmissions for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) were compared using logistic regression.
Key Results
Prior to MH implementation, the risk of all-cause ED visits for pre-MH residents was 0.93 (95% CI: 0.92–0.94) that of non-MH residents. After MH implementation, the relative risk for post-MH versus non-MH was 0.86 (95% CI: 0.85–0.87) and, over time, post-MH versus pre-MH was 0.93 (95% CI: 0.92–0.94). Hospitalization risks were generally lower among the pre-MH and post-MH, compared to non-MH. However, hospitalizations and HF or COPD readmissions were not generally lower post-MH compared to pre-MH.
Conclusions
This MH initiative was associated with a 7% reduction in risk of ED visits. More research is necessary to understand if ED visit risk will continue to improve and how other aspects of healthcare utilization might change as more MHs open and the length of exposure to MHs increases.