Intensive Outpatient Program Effects on High-need Patients' Access, Continuity, Coordination, and Engagement

Area of Science:

• Healthcare Management
• Patient Care Models
• Health Services Research

Background:

• High-need patients require intensive services, leading to new care delivery models.
• Evidence for the effectiveness of these new models is mixed.
• Patient-centered medical homes (PCMH) aim to improve primary care.

Purpose of the Study:

• To evaluate if augmenting a PCMH with intensive outpatient management improves care processes for high-need patients.
• To assess the impact on care continuity, access, coordination, and patient engagement.

Main Methods:

• Retrospective analysis using differences-in-differences and chi-squared tests.
• Compared 140 high-need patients in an intensive management program with those receiving usual PCMH care (out of 545 total).
• Evaluated effects on primary care visit continuity, telephone visit proportion, telehealth referral, advance directive completion, personal health record registration, missed appointments, and post-hospital discharge follow-up.

Main Results:

• Intensive management increased primary care visits with assigned physicians by 5.9% (P<0.001).
• Proportion of telephone-based visits increased by 17.9% (P<0.001).
• Telehealth referrals rose by 7.5% (P=0.01), advance directive completion by 17.2% (P<0.01), and personal health record registration by 9.3% (P=0.02).
• No significant effect on missed appointments or post-hospital discharge visit rates.

Conclusions:

• Augmenting a PCMH with intensive outpatient management shows potential benefits for high-need patients.
• Positive effects were observed in care continuity, access, coordination, and patient engagement.
• Further research may validate these findings for broader implementation.