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Licensed Unlicensed Requires Authentication Published by De Gruyter June 13, 2019

Health Care Home: Early Evidence from Linked Administrative Data in New Zealand

Kabir Dasgupta EMAIL logo and Gail Pacheco

Abstract

Our analysis presents a case study on the impacts of Health Care Home (HCH) – a large-scale technology-based healthcare innovation in New Zealand’s primary healthcare system. For our analysis, we link the registered population of health practices within the Wellington region to administrative hospital admission data for quarterly periods between 2014 and 2017. By employing variation in the timing of HCH implementation across practices (selected via propensity score matching), we estimate differences-in-differences models to investigate the effects of the intervention on multiple patient outcomes. Additionally, we incorporate a number of empirical specifications to test the robustness of estimates. HCH results in a statistically significant reduction in the likelihood of emergency department (ED) presentations by 6–8 %, with no significant impacts on other health outcomes. The impact on ED presentations aligns with the expectation that the HCH intervention would produce downstream effects of a reduced economic burden on public hospital services.

JEL Classification: I11; I18; C12

Appendix

A
Table 6:

Number of registered individuals per practice-quarter.

2014 Quarters2015 Quarters2016 Quarters2017 Quarters
HCH implementation quarterPractice1st2nd3rd4th1st2nd3rd4th1st2nd3rd4th1st2nd3rd4th
11,7731,7811,8031,8221,8291,8351,8641,8741,8881,8931,9241,9471,9681,9952,0402,079
2016q328,3028,4888,6418,8419,0059,1839,3609,6099,8059,97510,24410,47110,74210,98711,25711,645
31,4031,4281,4721,5071,5371,5571,5941,6221,6961,6831,7501,7921,8641,9252,0042,104
4373387395412420429442457462471476490514531549587
52,5672,6072,6462,7002,7322,7692,8332,8472,9012,9463,0013,0773,1593,2403,3163,414
2017q463,2013,2463,3053,3703,4423,5413,6503,7273,8633,9474,0734,2124,3554,5034,6594,850
2016q471,7591,8081,8261,8431,8671,9111,9521,9852,0232,0442,1082,1362,2052,2572,2872,357
86,5846,7266,8727,0667,2877,4367,6327,7977,9768,1368,4308,6388,8609,0909,3339,683
9693713724732757767784799811830849860877901923954
2017q3105,7375,8445,9746,1216,2376,3906,5536,7036,9537,1537,4067,6337,8158,1128,3508,673
118558808929219529721,0011,0431,0701,1151,1521,1771,2181,2791,3531,421
126416516656817257567998298478819109399719961,0251,056
2018q2131,8921,9221,9752,0322,1052,1792,2962,4082,5562,6612,8472,9773,1543,3223,4853,666
142,0562,0862,1162,1452,1612,1902,2372,2812,3082,3302,3862,4112,4402,4852,5352,609
153,7963,8223,8873,9814,0734,1384,1914,2114,2734,3404,3674,3844,4414,5224,5614,656
162,4892,5322,5582,6232,6542,6792,7232,7542,7892,8312,8572,9132,9623,0203,1073,185
2017q4177,0057,1147,2367,3557,4817,5997,7058,0688,1968,3388,4868,6128,7799,0099,1989,344
2018q1186,3266,3816,4476,5686,6446,7146,8076,8796,9767,0867,1887,2607,3477,4587,5907,720
2017q4195,3605,509
20373381382387401410418433437438441453468485497501
212,6032,6542,6992,7492,7812,8622,9102,9613,0383,1243,2023,2993,3983,4863,5823,712
221,8501,8831,8861,9071,9191,9561,9721,9952,0152,0282,0602,0792,0932,1112,1442,180
234,6834,7294,8014,8915,0045,1485,2705,4275,5895,6915,9406,1196,3796,6286,8147,056
243,5223,5693,6363,6913,7233,7673,8133,8903,9293,9773,9934,0874,1644,2854,3484,429
255,0315,1165,1905,2835,3785,4685,5675,6625,7505,8496,0056,1166,2306,3986,5316,698
263,5393,6003,6313,6573,6883,7443,8133,8624,0064,0934,2114,3234,4214,6084,7234,902
2017q3278,1468,2488,3538,4638,6398,7568,8718,9389,0489,1679,3369,4549,5969,81310,00210,207
2018q1281,5981,6161,6341,6491,6661,6841,7011,7121,7331,7561,7821,8171,8601,9031,9321,991
291,2481,2611,2811,2981,3051,3481,3861,4201,4421,4661,4901,5031,5131,5441,5821,607
2018q3304,6004,6554,7244,7984,8634,9245,0935,1575,2205,3105,4045,5075,6155,7345,8505,988
311,6091,6311,6721,7041,7211,7411,7631,7701,7741,7801,8071,8301,8551,8641,8861,913
326,6266,7316,8176,9037,0117,0987,1707,2577,3327,4637,5857,6997,8287,9698,1228,293
334,2324,3664,4094,4904,5524,6224,7124,7764,8694,9625,0435,1035,2035,3215,4625,586
341,8741,8831,9191,9651,9912,0362,1402,1722,2392,2452,3072,3542,3942,4682,5062,574
2016q3352,1982,2402,3012,3272,3622,3722,4012,4262,4742,5082,5482,5972,6312,6802,7452,822
362,2512,2762,2982,3222,3642,4132,4812,5422,5922,6412,7032,7502,8162,8682,9333,012
373,0743,1133,1353,1693,1993,2293,2533,2733,3193,3453,4183,4913,5433,6003,6503,731
385,5845,6415,7345,8535,9486,0606,1476,2596,3736,4816,6416,7516,8737,0527,2317,440
394,4174,4514,5174,5984,7184,7704,8664,9855,0725,1805,3055,4215,5225,6535,8115,943
2017q4403,1373,2043,2523,3363,4173,4753,5133,5423,5983,6343,7683,8263,8903,9504,0284,148
41269278276286283295313331344351360373387411431452
421,5761,6231,6681,7281,7501,7741,8161,8511,8761,9121,9581,9922,0322,0902,1522,289
2018q1434,1434,2014,2584,2924,3284,3714,4434,4694,5494,6234,7124,7714,8724,9655,0545,173
2018q2443,8593,9674,0554,1314,1724,2554,3634,4354,5084,5964,6594,7344,8424,9555,0665,231
2016q3456,6766,7516,8056,8606,9397,0637,1767,2817,4137,5017,6187,7207,8708,0638,2578,452
  1. Notes: The practice identifiers marked in bold implemented the health care homes model.

Table 7:

Difference-in-differences model with binary health events using all practices.

Dependent variables (binary indicator of health events)
Excess stayAcute admissionED admissionASH eventReadmission
Sample mean0.0110.0170.0150.0060.002
Model 1: Time and practice-specific fixed effects
HCH implementation−0.00035−0.00013−0.00120**−0.00024−0.00010
(0.00022)(0.00032)(0.00048)(0.00028)(0.00020)
Model 2: Model 1 + demographic controls (age, sex, ethnicity, quintile)
HCH implementation−0.00033−0.00010−0.00118**−0.00023−0.00009
(0.00023)(0.00032)(0.00050)(0.00029)(0.00016)
Model 3: Model 2 + practice-specific linear time trends
HCH implementation−0.000180.00011−0.00111***−0.000020.00011
(0.00030)(0.00034)(0.00033)(0.00018)(0.00027)
Model 4: Model 2 + event study
HCH implementation−0.000280.00002−0.00135***−0.00011−0.00003
(0.00029)(0.00031)(0.00038)(0.00023)(0.00022)
Pre-treatment (δpt)0.000000.000060.000030.000040.00001
(0.00004)(0.00005)(0.00005)(0.00003)(0.00002)
δptX HCH implementation−0.00004−0.00027*0.00001−0.00021**−0.00008
(0.00014)(0.00016)(0.00017)(0.00010)(0.00006)
Observations2,819,7512,819,7512,659,2602,819,7512,819,751
Individuals235,457
  1. Notes: The marginal effects from probit regressions using all the matched practices along with the respective standard errors (in parentheses) are reported in the above table. The standard errors are corrected for clustering at the practice-level. ***, **, * denote statistical significance at the 1 %, 5 %, and 10 % levels, respectively. We estimate probit regressions for Models 1–4.

  1. Conflict of Interest: The authors hereby acknowledge that the analysis does not involve any conflict of interest, as per the journal requirements.

References

Amarasingham, R., B. J. Moore, Y. P. Tabak, M. H. Drazner, C. A. Clark, S. Zhang, W. G. Reed, et al. 2010. “An Automated Model to Identify Heart Failure Patients at Risk for 30-Day Readmission or Death Using Electronic Medical Record Data.” Medical Care 48 (11): 981–88.10.1097/MLR.0b013e3181ef60d9Search in Google Scholar

Angrist, J., and S. Pischke. 2013. Mostly Harmless Econometrics: An Empiricists’ Companion. Princeton, NJ: Princeton University Press.Search in Google Scholar

Autor, D. H. 2003. “Outsourcing at Will: The Contribution of Unjust Dismissal Doctrine to the Growth of Employment Outsourcing.” Journal of Labor Economics 21 (1): 1–42.10.1086/344122Search in Google Scholar

Becker, S. O., and A. Ichino. 2002. “Estimation of Average Treatment Effects Based on Propensity Scores.” The Stata Journal 2 (4): 358–77.10.1177/1536867X0200200403Search in Google Scholar

Compass Health. 2017a. Compass Health Annual Report 2017. Wellington, New Zealand. Accessed July 17, 2018. http://annualreport.compasshealth.org.nz/2017/docs/Compass_Health_2017_Annual_Report.pdf.Search in Google Scholar

Compass Health. 2017b. “Health Care Home first year: Achievements and reflections.” Wellington, New Zealand. Accessed 25 June, 2018. http://www.compasshealth.org.nz/Portals/0/HCH/HCH-year-1-reflections.pdf.Search in Google Scholar

Compass Health. 2018. “Health Care Home Practices.” Wellington, New Zealand. Accessed 10 June, 2018. http://www.compasshealth.org.nz/PracticesandFees/HealthCareHomePractices.aspx.Search in Google Scholar

Downs, A. 2017. “From theory to practice: The promise of primary care in New Zealand.” Accessed 5 July, 2018. http://www.fulbright.org.nz/wp-content/uploads/2017/09/DOWNS-From-Theory-to-Practice-The-Promise-of-Primary-Care-in-New-Zealand-.pdf.Search in Google Scholar

Ernst & Young. 2018. Health Care Home Evaluation: Updated Analysis April-September 2017. New Zealand: Ernst & Young.Search in Google Scholar

Gilfillan, R. J., J. Tomcavage, M. B. Rosenthal, D. E. Davis, J. Graham, J. A. Roy, S. B. Pierdon, et al. 2010. “Value and the Medical Home: Effects of Transformed Primary Care.” The American Journal of Managed Care 16 (8): 607–14.Search in Google Scholar

Grant, R., and D. Greene. 2012. “The Health Care Home Model: Primary Health Care Meeting Public Health Goals.” American Journal of Public Health 102 (6): 1096–103.10.2105/AJPH.2011.300397Search in Google Scholar

Grumbach, K., and P. Grundy. 2010. Outcomes of Implementing Patient Centered Medical Home Interventions. Washington, DC: Patient-Centered Primary Care Collaborative.Search in Google Scholar

Health Care Home Collaborative. 2017. “Health Care Home model of care requirements.” Wellington, New Zealand. Accessed June 10, 2018. http://www.healthcarehome.co.nz/wp-content/uploads/2017/07/Health-Care-Home-Model-of-Care-Requirements.pdf.Search in Google Scholar

Health Care Home Collaborative. 2019. “An integrated care management model that benefits patients and practices.” Accessed April 20, 2019. https://www.healthcarehome.org.nz/integrated-health-care-management-nz.Search in Google Scholar

Hefford, M. 2017. “From Good to Great: The Potential for the Health Care Home Model to Improve Primary Health Care Quality in New Zealand.” Journal of Primary Health Care 9 (3): 230–33.10.1071/HC17045Search in Google Scholar

Jackson, G., and M. Tobias. 2001. “Potentially Avoidable Hospitalisations in New Zealand, 1989–98.” Australian and New Zealand Journal of Public Health 25 (3): 212–21.10.1111/j.1467-842X.2001.tb00565.xSearch in Google Scholar

Jiang, N., and G. Pacheco. 2014. “Demand in New Zealand Hospitals: Expect the Unexpected?” Applied Economics 46 (36): 4475–89.10.1080/00036846.2014.964830Search in Google Scholar

Khandker, S., G. B. Koolwal, and H. Samad. 2010. Handbook on Impact Evaluation: Quantitative Methods and Practices. Washington, DC: The World Bank.10.1596/978-0-8213-8028-4Search in Google Scholar

Larson, E. B., and R. Reid. 2010. “The Patient-Centered Medical Home Movement: Why Now?” Jama 303 (16): 1644–45.10.1001/jama.2010.524Search in Google Scholar

Maeng, D. D., J. Graham, T. R. Graf, J. N. Liberman, N. B. Dermes, J. Tomcavage, D. E. Davis, F. J. Bloom Jr., G. D. Steele. 2012. “Reducing Long-Term Cost by Transforming Primary Care: Evidence from Geisinger’s Medical Home Model.” The American Journal of Managed Care 18 (3): 149–55.Search in Google Scholar

Martsolf, G. R., J. A. Alexander, Y. Shi, L. P. Casalino, D. R. Rittenhouse, D. P. Scanlon, and S. M. Shortell. 2012. “The Patient‐Centered Medical Home and Patient Experience.” Health Services Research 47 (6): 2273–95.10.1111/j.1475-6773.2012.01429.xSearch in Google Scholar

McCarthy, D., K. Mueller, and I. Tillmann. 2009. Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home. New York: The Commonwealth Fund.Search in Google Scholar

McClelland, M., B. Asplin, S. K. Epstein, K. E. Kocher, R. Pilgrim, J. Pines, E. J. Rabin, N. K. Rathlev. 2014. “The Affordable Care Act and Emergency Care.” American Journal of Public Health 104 (10): e8–e10.10.2105/AJPH.2014.302052Search in Google Scholar

McHugh, M. D., and C. Ma. 2013. “Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia.” Medical Care 51 (1): 52.10.1097/MLR.0b013e3182763284Search in Google Scholar

Middleton, L., P. Dunn, C. O’Loughlin, and J. Cumming. 2018. Taking Stock: Primary Care Innovation. Wellington, New Zealand: Productivity Commission. Accessed August 2, 2018. https://www.productivity.govt.nz/sites/default/files/Taking%20Stock%20Primary%20Care%20Innovation_Victoria%20University%20Wellington.pdf.Search in Google Scholar

Ministry of Health NZ. 2018. “Enrolment in a primary health organisation.” Accessed August 17, 2018. https://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation.Search in Google Scholar

Mutter, R. L., M. D. Rosko, and H. S. Wong. 2008. “Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness.” Health Services Research 43 (6): 1992–2013.10.1111/j.1475-6773.2008.00892.xSearch in Google Scholar

Pinnacle Midlands Health Network. 2018. “Our Health Care Home Journey.” Health Care Home. Accessed July 17, 2018. http://www.healthcarehome.co.nz/model-overview/.Search in Google Scholar

Rosenberg, C. N., P. Peele, D. Keyser, S. McAnallen, and D. Holder. 2012. “Results from a Patient-Centered Medical Home Pilot at UPMC Health Plan Hold Lessons for Broader Adoption of the Model.” Health Affairs 31 (11): 2423–31.10.1377/hlthaff.2011.1002Search in Google Scholar

Werner, R. M., A. Canamucio, J. A. Shea, and G. True. 2014. “The Medical Home Transformation in the Veterans Health Administration: An Evaluation of Early Changes in Primary Care Delivery.” Health Services Research 49 (4): 1329–47.10.1111/1475-6773.12155Search in Google Scholar

Zhan, C., and M. R. Miller. 2003. “Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries during Hospitalization.” Jama 290 (14): 1868–74.10.1001/jama.290.14.1868Search in Google Scholar

Published Online: 2019-06-13

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