Chronic Disease Outcomes From Primary Care Population Health Program Implementation

AJMC December 12, 2017
Jeffrey M. Ashburner, PhD, MPH; Daniel M. Horn, MD; Sandra M. O’Keefe, MPH; Adrian H. Zai, MD, PhD; Yuchiao Chang, PhD; Neil W. Wagle, MD, MBA; and Steven J. Atlas, MD, MPH

Patients in practices with central population health coordinators had greater improvement in short-term chronic disease outcome measures compared with patients in practices without central support.

ABSTRACT

Objectives: We implemented a health information technology–enabled population health management program for chronic disease management in academic hospital–affiliated primary care practices, then compared quality-of-care outcome measures among practices assigned a central population health coordinator (PHC) and those not assigned a PHC.

Study Design: Quasi-experimental.

Methods: Central PHCs were nonrandomly assigned to 8 of 18 practices. They met with physicians, managed lists of patients not at goal in chronic disease registries, and performed administrative tasks. In non-PHC practices, existing staff remained responsible for these tasks. The primary outcome was difference-in-differences over the 6-month follow-up period...

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