# Identifying Primary Care Practice Components Leading to Optimal Diabetes Care in Patient-Centered Medical Homes

> **NIH NIH R18** · UNIVERSITY OF MINNESOTA · 2020 · $488,439

## Abstract

Abstract
 Although national measures of the quality of diabetes care delivery demonstrate improvement, progress has
been slow. Throughout the United States, primary care presents a critical leverage point for improving diabetes
outcomes, but improving support for diabetes care in primary care practices requires a new model of care
delivery that increases coordination, emphasizes prevention, and enhances collaboration between
multidisciplinary teams. Legislative initiatives focusing on health care reform have accelerated adoption of the
Patient Centered Medical Home (PCMH) as the preferred model for primary care redesign, with improvement
in diabetes care being the most common initial focus. The organizing principles of the PCMH are well
established, however operational definitions vary and important gaps exist in our understanding about which
domains of change drive practice improvement, which services or resources are most likely to improve clinical
outcomes, and the circumstances under which new services might succeed or fail when introduced by a
practice. A better understanding of the impact of component services across organizational domains is
essential for widespread adoption of incremental change in practice. Such an evaluation is critical for
informing the adoption of new models of primary care and for determining whether new PCMH services
provide consistent benefits across multiple settings and across diverse diabetes populations.
 In 2008 the Minnesota legislature adopted pioneering legislative health care reform that established
standardized criteria for PCMH certification including a comprehensive set of specific services and resources.
Since that time, 384 (66%) of the 581 eligible practices in Minnesota supporting care for 3.64 million people
have become PCMH certified. This `natural experiment' provides a unique opportunity to leverage the data
collected as a result of this reform and prior policy collaboratives to intensively evaluate the impact of primary
care practice redesign on diabetes care and outcomes. The overall goal of this proposal is to identify the
specific services and resources associated with primary care PCMH practice redesign that result in the
greatest improvement in diabetes care. The study evaluates change across multiple organizational domains
and its impact on diabetes care and health care utilization, adjusting for differences in practice and patient
characteristics. Our analyses use difference-in-differences, propensity scoring in a Bayesian framework, and
instrumental variable methods to draw causal conclusions under increasingly flexible assumptions about the
non-random nature of PCMH certification. Overall, the proposal provides a unique opportunity to discover
better ways of providing care for individuals with diabetes, and has the potential to stimulate national change in
the delivery of diabetes care in primary care settings.

## Key facts

- **NIH application ID:** 9939522
- **Project number:** 5R18DK110732-05
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** CAROLINE S CARLIN
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $488,439
- **Award type:** 5
- **Project period:** 2016-07-16 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9939522

## Citation

> US National Institutes of Health, RePORTER application 9939522, Identifying Primary Care Practice Components Leading to Optimal Diabetes Care in Patient-Centered Medical Homes (5R18DK110732-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9939522. Licensed CC0.

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