Abstract Although national measures of the quality of diabetes care delivery demonstrate improvement, progress has been slow. In 2008, the Minnesota legislature endorsed the patient-centered medical home (PCMH) as the preferred model for primary care redesign. In this work, we investigate the effect of PCMH-related clinic redesign and resources on diabetes outcomes from 2008 to 2012 among Minnesota clinics certified as PCMHs by 2011 by using a Bayesian framework for a continuous difference-in-differences model. Data from the Physician Practice Connections-Research Survey were used to assess a clinic’s maturity in primary care transformation, and diabetes outcomes were obtained from the MN Community Measurement program. These data have several characteristics that must be carefully considered from a modeling perspective, including the inability to match patients over time, the potential for dynamic confounding, and the hierarchical structure of clinics. An ad-hoc analysis suggests a significant correlation between PCMH-related clinic redesign and resources on diabetes outcomes; however, this effect is not detected after properly accounting for different sources of variability and confounding. Supplementary materials for this article are available online.

中文翻译：

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贝叶斯差异框架，用于重新设计初级保健对糖尿病结局的影响

摘要尽管国家对糖尿病护理质量的衡量指标有所改善，但进展缓慢。2008年，明尼苏达州立法机关批准了以患者为中心的医疗之家（PCMH），作为重新设计初级保健的首选模型。在这项工作中，我们使用贝叶斯框架进行连续差异模型研究，调查了PCMH相关诊所的重新设计和资源对2008年至2012年间在明尼苏达州获得PCMH认证的诊所中糖尿病结局的影响。来自医师实践联系研究调查的数据用于评估诊所在初级保健转型中的成熟度，而糖尿病结局则是从MN社区评估计划中获得的。这些数据具有几个特征，必须从建模角度仔细考虑这些特征，包括无法随时间匹配患者，动态混淆的可能性以及诊所的层次结构。一项临时分析表明，与PCMH相关的诊所重新设计与糖尿病预后资源之间存在显着相关性。但是，在适当考虑了可变性和混淆性的不同来源之后，无法检测到这种影响。可在线获得本文的补充材料。