Improving Access to Improve Quality in an HMO

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DESCRIPTION (Provided by applicant): Background and Significance. In Crossing the Quality Chasm, the Institute of Medicine concludes that U.S. health care is plagued by low quality, and recommends that quality can be improved partly by creating "patient-centered" delivery systems offering "continuous access" to healthcare. Group Health Cooperative (GHC) has launched an Access Initiative to improve quality by increasing enrollee access to physicians and information through the following system reforms: health promotion information on the MyGroupHealth (MyGH) enrollee Web portal; patient-provider secure messaging through MyGH with physician financial incentives for messaging; advanced access to primary care; primary care system redesign to control costs; direct access to specialist physicians (removal of gatekeeping); changes in primary and specialty physician compensation; and Internet access for enrollees to their electronic medical records. The GHC reforms may benefit patients with multiple chronic conditions, based on the IOM recommendations. Aims. For the population of enrollees with type 2 diabetes mellitus continuously enrolled in Group Health between 1997-2006, aims are to: 1) Estimate the baseline prevalence and incidence of other chronic conditions between 1997-2006, emphasizing heart disease, hypertension, congestive heart failure and depression; 2) Estimate utilization of Web-based patient-provider secure messaging, electronic medical records, and health promotion information; 3) Compare provider visits, hospital use, and costs before vs. after the Initiative; and 4) Compare continuity and quality of care before vs. after the Initiative. Study Design. In Aims 1 and 2, a longitudinal cohort design will be used to estimate baseline, prevalence and incidence of type 2 diabetes, and to estimate enrollee utilization of the Initiative's components for three mutually-exclusive cohorts in GHC's population of 16,561 continuously enrolled adults > age 18 with diabetes: 1) Prevalence cohort of enrollees who had diabetes and one or more other chronic conditions in 1997; 2) Incidence cohort of enrollees who developed one or more other chronic conditions in 1998-2006; and 3) a Diabetes only cohort with no other chronic conditions 1997-2006. In Aims 3-4, single interrupted time series design will be used to compare utilization, cost and quality before vs. after the Initiative. Population. Group Health enrollees who are continuously enrolled 1997-2006 with diabetes in western Washington state (approximately N= 16,561). Measures. Enrollee use of secure messaging and MyGH, outpatient and hospital use, ER use, costs and quality of care. Data Sources. Group Health automated data bases. Analyses. Descriptive, bivariate, regression, and time series analyses will be performed.