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Impact of Patient-Centered Medical Home Assignment on Emergency Room Visits Among Uninsured Patients in a County Health System (Medical Care Research and Review)

August 1, 2010

Journal Article

Authors: Dan Castillo, Nadereh Pourat, PhD, Matthew J. Pirritano, Shelley M. Vrungos, Himmet Dajee, Dan Castillo, Gerald F. Kominski, PhD

In this journal article, the authors examine the Medical Services Initiative program — a safety net-based system of care — in Orange County, which assigned uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment.

Among the findings: Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.

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