Intensive Outpatient Program Effects on High-need Patients' Access, Continuity, Coordination, and Engagement

Med Care. 2018 Jan;56(1):19-24. doi: 10.1097/MLR.0000000000000833.


Objective: The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patients' care processes.

Research design: Retrospective analysis using differences-in-differences and χ tests.

Subjects: Of 545 high-need patients receiving PCMH care, 140 were previously randomly selected for the intensive outpatient management program; the remaining received usual care.

Measures: We evaluated program effects on care continuity (proportion of primary care visits with assigned primary care physician); access (proportion of telephone visits out of all primary care encounters, missed appointment rate); care coordination (rate of follow-up after hospital discharge, new telehealth enrollment); and patient engagement (rates of online personal health record registration, advance directive completion).

Results: Compared with patients receiving usual care, patients enrolled in intensive management experienced a 5.9% increase in proportion of primary care visits with an assigned primary care physician (P<0.001) and a 17.9% increase in proportion of telephone-based visits (P<0.001). Patients in the program had 7.5% higher rates of telehealth referral (P=0.01), 17.2% higher rates of advance directive completion (P<0.01), and 9.3% higher rates of personal health record registration (P=0.02). There was no effect on missed appointments or posthospital discharge visit rates.

Conclusions: Augmenting a PCMH with intensive outpatient management may have positive effects on primary care processes related to continuity, access, coordination, and patient engagement.

Publication types

  • Evaluation Study

MeSH terms

  • Aftercare / methods*
  • Aged
  • Ambulatory Care / statistics & numerical data*
  • Chi-Square Distribution
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outpatients / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Program Evaluation
  • Retrospective Studies