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Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management among Primary Care Patients in Sydney, Australia

Author

Listed:
  • James Rufus John

    (Translational Health Research Institute, Western Sydney University, New South Wales 2560, Australia
    Rozetta Institute, Level 4, 55 Harrington Street, Sydney, New South Wales 2000, Australia)

  • Amanda Jones

    (Sonic Clinical Services, Level 21, 225 George Street, Sydney, New South Wales 2000, Australia)

  • A. Munro Neville

    (AusTrials, Queensland 4068, Australia)

  • Shima Ghassempour

    (Research Implementation Science and eHealth Group, Faculty of Health Science, The University of Sydney, New South Wales 2006, Australia)

  • Federico Girosi

    (Translational Health Research Institute, Western Sydney University, New South Wales 2560, Australia
    Rozetta Institute, Level 4, 55 Harrington Street, Sydney, New South Wales 2000, Australia)

  • W. Kathy Tannous

    (Translational Health Research Institute, Western Sydney University, New South Wales 2560, Australia
    School of Business, Western Sydney University, New South Wales 2150, Australia)

Abstract

Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called ‘WellNet’ delivered across six primary care practices in Sydney, Australia. The WellNet study sample comprises 589 consented participants in the intervention group receiving enhanced primary care in the form of patient-tailored chronic disease management plan, improved self-management support, and regular monitoring by general practitioners (GPs) and trained clinical coordinators. The comparison group consisted of 7750 patients who were matched based on age, gender, type and number of chronic diseases who received standard GP care. Data collected include sociodemographic characteristics, clinical measures, and self-reported health assessments at baseline and 12 months. Early study findings show the mean age of the study participants was 70 years with nearly even gender distribution of males (49.7%) and females (50.3%). The most prevalent chronic diseases in descending order were circulatory system disorders (69.8%), diabetes (47.4%), musculoskeletal disorders (43.5%), respiratory diseases (28.7%), mental illness (18.8%), and cancer (13.6%). To our knowledge, the WellNet study is the first study in Australia to generate evidence on the feasibility of design, recruitment, and implementation of a comprehensive PCMH model. Lessons learned from WellNet study may inform other medical home models in Australian primary care settings.

Suggested Citation

  • James Rufus John & Amanda Jones & A. Munro Neville & Shima Ghassempour & Federico Girosi & W. Kathy Tannous, 2020. "Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management among Primary Care Patients in Sydney, Australia," IJERPH, MDPI, vol. 17(6), pages 1-21, March.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:6:p:2164-:d:336441
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    References listed on IDEAS

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    1. Zhijun Tan & Ying Liang & Siming Liu & Wenjun Cao & Haibo Tu & Lingxia Guo & Yongyong Xu, 2013. "Health-Related Quality of Life as Measured with EQ-5D among Populations with and without Specific Chronic Conditions: A Population-Based Survey in Shaanxi Province, China," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-10, July.
    2. Deborah Peikes & Arnold Chen & Jennifer Schore & Randall Brown, 2009. "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials," Mathematica Policy Research Reports ce70f11be1b44e2c8590b9cf5, Mathematica Policy Research.
    3. repec:mpr:mprres:6184 is not listed on IDEAS
    4. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2012. "Causal Inference without Balance Checking: Coarsened Exact Matching," Political Analysis, Cambridge University Press, vol. 20(1), pages 1-24, January.
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    Cited by:

    1. Shilpa Surendran & Chuan De Foo & Chen Hee Tam & Elaine Qiao Ying Ho & David Bruce Matchar & Josip Car & Gerald Choon Huat Koh, 2021. "The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context," IJERPH, MDPI, vol. 18(4), pages 1-11, February.

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