Baughman Amy W, Brawarsky Phyllis, Onega Tracy, Tosteson Tor D, Wang Qianfei, Tosteson Anna N A, Haas Jennifer S
Brigham and Women's Hospital, 1620 Tremont St, 3rd Fl, Boston, MA 02120. E-mail:
Am J Manag Care. 2016 Nov 1;22(11):e382-e388.
The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service.
Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts.
Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements. We included women aged 50 to 74 years who had at least 1 primary care visit at a participating clinic between April 2012 and December 2013 (n = 20,349)-a period of medical home transformation. The main measures included: a) whether screening was up-to-date at the time of the visit (mammography completion within 24 months prior to the visit); and b) if screening was overdue at the visit (ie, it had been more than 24 months since the last mammogram), and whether timely screening was completed within 3 months after the visit.
In adjusted analyses, PCMH transformation scores were negatively associated with up-to-date screening status (odds ratio [OR] for a 20-point change, 0.93; 95% confidence interval [CI], 0.89-0.96) and with timely screening of women who were overdue (OR, 0.94; 95% CI, 0.87-1.02).
Preventative care, such as breast cancer screening, may not improve in early PCMH implementation.
以患者为中心的医疗之家（PCMH）作为一种初级保健服务提供系统，其影响力持续增强。我们评估了初级保健机构向医疗之家的转变是否与乳腺癌筛查（一项广泛认可的预防性服务）的使用有关。
回顾性队列研究，评估马萨诸塞州大波士顿地区的12家与布莱根妇女医院（BWH）相关的初级保健诊所。
使用根据美国国家质量保证委员会认可要求制定的连续PCMH转变评分（范围 = 0 - 100），每季度对机构转变情况进行衡量。我们纳入了年龄在50至74岁之间、在2012年4月至2013年12月期间（医疗之家转变期）在参与研究的诊所至少进行过1次初级保健就诊的女性（n = 20349）。主要衡量指标包括：a）就诊时筛查是否最新（就诊前24个月内完成乳房X线摄影）；b）就诊时筛查是否逾期（即自上次乳房X线摄影以来已超过24个月），以及就诊后3个月内是否及时完成筛查。
在调整分析中，PCMH转变评分与最新筛查状态呈负相关（20分变化的优势比[OR]为0.93；95%置信区间[CI]，0.89 - 0.96），与逾期女性的及时筛查也呈负相关（OR，0.94；95% CI，0.87 - 1.02）。
在早期实施PCMH时，诸如乳腺癌筛查等预防性护理可能不会得到改善。
