OBJECTIVES

To evaluate changes in the performance of guideline-based diabetes processes of care associated with the implementation of medical homes (MHs) in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy.

METHODS

We conducted a retrospective cohort study (01/01/2011-12/31/2017) using the Parma LHA administrative healthcare database to examine changes in diabetes care processes (HbA1c, lipids, creatinine, microalbumin, eye exams, and electrocardiogram (ECG)) associated with MH implementation. Included patients had diabetes, lived in Parma >1 year, were ≥14 years of age, and had a documented primary care physician (PCP). Exposure to MH care was time-varying and operationalized using three levels (non-MH, pre-MH, and post-MH) to adjust for potential physician selection into MHs. Each day of follow-up was classified as compliant or not compliant with recommended screening intervals. Negative binomial regression models were used to estimate adjusted incidence rate ratios for each measure.

RESULTS

Over 7 years, the study followed 49,039 patients and of 163,900 person-years of follow-up, 22% were exposed to MHs. When comparing pre-MH versus non-MH, pre-MH individuals had higher rates of compliance with HbA1c [IRR=1.05 95% CI (1.04, 1.07)], microalbumin [IRR=1.18 95% CI (1.15, 1.20)], and eye exams [IRR=1.05 95% CI (1.04, 1.06)]. Patients in the post-MH versus non-MH group had higher rates of compliance with all 6 measures. Comparing post-MH and pre-MH, post-MH was associated with higher rates of compliance with HbA1c [IRR=1.02 95% CI (1.01, 1.03)], lipid panels [IRR=1.08 95% CI (1.07, 1.09)], creatinine [IRR=1.11 95% CI (1.10, 1.12)] and ECG [IRR=1.16 95% CI (1.14, 1.18)], but lower rates of microalbumin testing and eye examinations.

CONCLUSIONS

Accounting for pre-existing differences, patients with diabetes who were cared for by a PCP in a MH had higher rates of compliance with several diabetes care processes. These findings suggest that implementing the medical home model may improve microvascular and macrovascular outcomes for these patients.