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.
Bibliographical noteFunding 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.
©, Published with license by American Statistical Association. ©, © James Normington, Eric Lock, Caroline Carlin, Kevin Peterson and Brad Carlin.
- Bayesian hierarchical modeling
- Errors in covariates
- Patient-centered medical home
- Primary care redesign