TY - JOUR
T1 - Impact of a primary care provider Tele-mentoring and community health worker intervention on utilization in Medicaid patients with diabetes
AU - Blecker, Saul
AU - Lemieux, Emily
AU - Paul, Margaret M.
AU - Berry, Carolyn A.
AU - Bouchonville, Matthew F.
AU - Arora, Sanjeev
AU - Billings, John
N1 - Funding Information:
Both the Endo ECHO intervention and the external evaluation were supported by The Leona M. and Harry B. Helmsley Charitable Trust.
Funding Information:
This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust. An earlier version of the abstract was presented at the 79th American Diabetes Association Scientific Sessions in San Francisco, California.
Funding Information:
This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust. Emily Lemeiux contributed to this study when working at NYU School of Medicine and is currently employed at Flatiron Health, Inc., which is an independent subsidiary of the Roche Group; E.L. reports stock ownership in Roche. The authors have no other multiplicity of interest to disclose.
Publisher Copyright:
© 2020 AACE.
PY - 2020/10
Y1 - 2020/10
N2 - Objective: The Endocrinology ECHO intervention utilized a tele-mentoring model that connects primary care providers (PCPs) and community health workers (CHWs) with specialists for training in diabetes care. We evaluated the impact of the Endo ECHO intervention on healthcare utilization and care for Medicaid patients with diabetes in New Mexico. Methods: Between January 2015 and April 2017, patients with complex diabetes from 10 health centers in NM were recruited to receive diabetes care from a PCP and CHW upskilled through Endo ECHO. We matched intervention patients in the NM Medicaid claims database to comparison Medicaid beneficiaries using 5:1 propensity matching. We used a difference-in-difference (DID) approach to compare utilization and processes of care between intervention and comparison patients. Results: Of 541 Medicaid patients enrolled in Endo ECHO, 305 met inclusion criteria and were successfully matched. Outpatient visits increased with Endo ECHO for intervention patients as compared to comparison patients (rate ratio, 1.57; 95% confidence interval [CI], 1.43 to 1.72). The intervention was associated with an increase in emergency department (ED) visits (rate ratio, 1.30; 95% CI, 1.04 to 1.63) but no change in hospitalizations (rate ratio, 1.47; 95% CI, 0.95 to 2.23). Among intervention patients, utilization of metformin increased from 57.1% to 60.7%, with a DID between groups of 8.8% (95% CI, 4.0% to 13.6%). We found similar increases in use of statins (DID, 8.5%; 95% CI, 3.2% to 13.8%), angiotensin-converting enzyme inhibitors (DID, 9.5%; 95% CI, 3.5% to 15.4%), or antidepressant therapies (DID, 9.4%; 95% CI, 1.1% to 18.1%). Conclusion: Patient enrollment in Endo ECHO was associated with increased outpatient and ED utilization and increased uptake of prescription-related quality measures. No impact was observed on hospitalization. (Endocr Pract. 2020;26:1070-1076).
AB - Objective: The Endocrinology ECHO intervention utilized a tele-mentoring model that connects primary care providers (PCPs) and community health workers (CHWs) with specialists for training in diabetes care. We evaluated the impact of the Endo ECHO intervention on healthcare utilization and care for Medicaid patients with diabetes in New Mexico. Methods: Between January 2015 and April 2017, patients with complex diabetes from 10 health centers in NM were recruited to receive diabetes care from a PCP and CHW upskilled through Endo ECHO. We matched intervention patients in the NM Medicaid claims database to comparison Medicaid beneficiaries using 5:1 propensity matching. We used a difference-in-difference (DID) approach to compare utilization and processes of care between intervention and comparison patients. Results: Of 541 Medicaid patients enrolled in Endo ECHO, 305 met inclusion criteria and were successfully matched. Outpatient visits increased with Endo ECHO for intervention patients as compared to comparison patients (rate ratio, 1.57; 95% confidence interval [CI], 1.43 to 1.72). The intervention was associated with an increase in emergency department (ED) visits (rate ratio, 1.30; 95% CI, 1.04 to 1.63) but no change in hospitalizations (rate ratio, 1.47; 95% CI, 0.95 to 2.23). Among intervention patients, utilization of metformin increased from 57.1% to 60.7%, with a DID between groups of 8.8% (95% CI, 4.0% to 13.6%). We found similar increases in use of statins (DID, 8.5%; 95% CI, 3.2% to 13.8%), angiotensin-converting enzyme inhibitors (DID, 9.5%; 95% CI, 3.5% to 15.4%), or antidepressant therapies (DID, 9.4%; 95% CI, 1.1% to 18.1%). Conclusion: Patient enrollment in Endo ECHO was associated with increased outpatient and ED utilization and increased uptake of prescription-related quality measures. No impact was observed on hospitalization. (Endocr Pract. 2020;26:1070-1076).
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U2 - 10.4158/EP-2019-0535
DO - 10.4158/EP-2019-0535
M3 - Article
C2 - 32576033
AN - SCOPUS:85096298118
SN - 1530-891X
VL - 26
SP - 1070
EP - 1076
JO - Endocrine Practice
JF - Endocrine Practice
IS - 10
ER -