January 13, 2023
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Medicare beneficiaries who received care from clinics participating in Maryland’s advanced primary care program had lower rates of COVID-19-related hospitalizations and deaths than those receiving care at nonparticipating sites, data show.
Emily Gruber, MBA, MPH, MDPCP, health equity manager of the Maryland Primary Care Program (MDPCP), and colleagues sought to understand the connection between advanced primary care — “a team-based approach to providing higher-quality primary care” — and COVID-19 outcomes, including case, hospitalization , vaccination and death rates, during the pandemic’s first 2 years, the researchers wrote in JAMA Network Open.
Data derived from: Gruber E, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2022.49791.
They specifically focused on the impact of MDPCP, which “produced a model of integration between primary care and public health in the pandemic response,” they wrote.
Howard Haft, MD, MMM, CPE, FACPE, a senior medical adviser for MDPCP and coauthor of the study, told Healio that MDPCP is a “statewide advanced primary care program that includes team-based care, site-based care management, advanced health information technology, integration of behavioral health care into every practice and a strong focus on health equity.”
“MDPCP provides a framework and support for advanced primary care that addresses the medical and social needs of the patients using state-of-the-art tools and techniques,” he said. “The coordination with the state department of health and the integration of public health data tools enhances the population-based outcomes.”
MDPCP participation is voluntary, the researchers wrote, but when a practice opts in, it works with an assigned MDH practice coach who facilitates the relationship between the state public health department and the practice.
“The MDPCP is unique in its integration of primary care and state public health,” Gruber and colleagues wrote.
The researchers conducted a retrospective cohort study using Maryland state vaccination data and Medicare claims data from January 2020 through January 2022.
The researchers divided the study population into beneficiaries in MDPCP — 208,146 people — and a matched cohort of beneficiaries outside of MDPCP practices — 37,203 people.
Of the participants, 60.1% were women and 78.4% were white with a median age of 76 years.
Gruber, Haft and colleagues found that MDPCP beneficiaries had “more favorable” COVID-19-related outcomes than those who were not involved in the program. Vaccination rates were better, with 84.47% of MDPCP beneficiaries being fully vaccinated compared with 77.93% (P < .001). Telehealth rates were also higher, at 62.95% vs. 54.53% (P < .001), and people who tested positive for COVID-19 in MDPCP received monoclonal antibody treatment more often, at 8.45% vs 6.11% (P < .001) .
Additionally, people in MDPCP had lower rates of COVID-19 inpatient admissions, at 1.81% vs. 2.06% (P = .001), lower rates of COVID-19 cases, at 6.55% vs. 7.09% (P < .001) and lower death rates, at 0.56% vs. 0.77% (P < .001), compared with beneficiaries in the non-MDPCP group.
Haft said that primary care providers could learn three things from this study:
- “working in coordination with public health can improve patient outcomes”;
- “there is power in having a broad state based advanced primary care program”; other
- “strong and well-organized and supported primary care is critical to the health security of states and the nation.”
He added that “there is an opportunity now for other states to work with federal partners to establish strong, coordinated and adequately funded state based primary care programs.”
“The pandemic has demonstrated the importance of primary care and this study has demonstrated how such a program can save lives,” he said.
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