Small Primary Care Practices Face Four Hurdles—Including A Physician-Centric Mind-Set—In Becoming Medical Homes

2012 ◽  
Vol 31 (11) ◽  
pp. 2417-2422 ◽  
Author(s):  
Paul A. Nutting ◽  
Benjamin F. Crabtree ◽  
Reuben R. McDaniel
2017 ◽  
Vol 20 (5) ◽  
pp. 411-418 ◽  
Author(s):  
Robert D. Lieberthal ◽  
Tom Karagiannis ◽  
Evan Bilheimer ◽  
Manisha Verma ◽  
Colleen Payton ◽  
...  

2019 ◽  
Vol 17 (Suppl 1) ◽  
pp. S17-S23 ◽  
Author(s):  
Erin S. Rogers ◽  
Allison M. Cuthel ◽  
Carolyn A. Berry ◽  
Sue A. Kaplan ◽  
Donna R. Shelley

2016 ◽  
Vol 29 (6) ◽  
pp. 767-774 ◽  
Author(s):  
G. Gimm ◽  
J. Want ◽  
D. Hough ◽  
T. Polk ◽  
M. Rodan ◽  
...  

2013 ◽  
Vol 202 (6) ◽  
pp. 441-446 ◽  
Author(s):  
Jochen Gensichen ◽  
Juliana J. Petersen ◽  
Michael Von Korff ◽  
Dirk Heider ◽  
Steffen Baron ◽  
...  

BackgroundCase management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression.AimsTo evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices.MethodCost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental costeffectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of qualityadjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086.ResultsIntervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and ‘dominance’ of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%.ConclusionsIn small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.


2015 ◽  
Vol 72 (4) ◽  
pp. 438-467 ◽  
Author(s):  
Jeffrey A. Alexander ◽  
Amanda R. Markovitz ◽  
Michael L Paustian ◽  
Christopher G. Wise ◽  
Darline K. El Reda ◽  
...  

2019 ◽  
Vol 17 (Suppl 1) ◽  
pp. S83-S83 ◽  
Author(s):  
Lauren Gritzer ◽  
Marsha Davenport ◽  
Michael Dark ◽  
Niharika Khanna

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