A Bayesian Difference-in-Difference Framework for the Impact of Primary Care Redesign on Diabetes Outcomes

James Normington, Eric Lock, Caroline Carlin, Kevin Peterson, Bradley Carlin

Research output: Contribution to journalArticlepeer-review

Abstract

Although national measures of the quality of diabetes care delivery demonstrate improvement, progress has been slow. In 2008, the Minnesota legislature endorsed the patient-centered medical home (PCMH) as the preferred model for primary care redesign. In this work, we investigate the effect of PCMH-related clinic redesign and resources on diabetes outcomes from 2008 to 2012 among Minnesota clinics certified as PCMHs by 2011 by using a Bayesian framework for a continuous difference-in-differences model. Data from the Physician Practice Connections-Research Survey were used to assess a clinic’s maturity in primary care transformation, and diabetes outcomes were obtained from the MN Community Measurement program. These data have several characteristics that must be carefully considered from a modeling perspective, including the inability to match patients over time, the potential for dynamic confounding, and the hierarchical structure of clinics. An ad-hoc analysis suggests a significant correlation between PCMH-related clinic redesign and resources on diabetes outcomes; however, this effect is not detected after properly accounting for different sources of variability and confounding. Supplementary materials for this article are available online.

Original languageEnglish (US)
Pages (from-to)55-66
Number of pages12
JournalStatistics and Public Policy
Volume6
Issue number1
DOIs
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH funding: R18DK110732). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
©, Published with license by American Statistical Association. ©, © James Normington, Eric Lock, Caroline Carlin, Kevin Peterson and Brad Carlin.

Keywords

  • Bayesian hierarchical modeling
  • Diabetes
  • Difference-in-differences
  • Errors in covariates
  • Patient-centered medical home
  • Primary care redesign

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