In response to the high prevalence of chronic diseases among older adults in Australia, the Health Care Homes (HCH) initiative was implemented as a primary care trial from October 2017 to June 2021. The HCH model aimed to improve the management of patients with multiple chronic conditions by integrating patient-centered medical home principles, which focus on comprehensive and coordinated care facilitated through bundled payments.
This quasi-experimental study analysed data from 227 practices enrolled in the HCH initiative across ten Primary Health Networks. The participant pool consisted of more than 11,000 individuals, matched in a 1:1 ratio with a control group receiving usual care, based on propensity scores. The study assessed various outcomes, including access to care, care processes, and clinical outcomes for chronic conditions like diabetes, using practice data extracts and linked administrative data.
The findings indicated several positive outcomes for patients enrolled in HCH. During the first year, these patients had higher rates of general practitioner encounters and allied health service claims compared to those in usual care. There was also a notable increase in annual influenza vaccinations and routine monitoring of health markers such as blood pressure, blood lipids, and kidney function. However, the data did not show significant improvements in diabetes management or overall reductions in emergency department visits and hospital admissions, except for a slight increase in such events during the first year. Mortality rates between the two groups were similar.
While the HCH model enhanced access to care and improved healthcare processes, it did not significantly affect diabetes outcomes, most hospital use measures, or mortality rates. These findings suggest that while patient-centered medical homes can improve service delivery and patient engagement in care, translating these improvements into better clinical outcomes remains challenging. This highlights the need for further research and potentially longer trial periods to capture the full impact of such models on chronic disease management and to fully assess the effectiveness of patient-centered care initiatives in primary healthcare settings in Australia.
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