Table A3.

Marginal Effect of Increasing Maturity by Patient-Centered Medical Home Domain (Relative to Early Stage Transformation) by Patient Comorbidity Status

	Marginal Effect of Maturity on Utilization Measures (P Value)
	Intermediate-Stage Domain	Late-Stage Domain
Diabetes mellitus
Total utilization^*
Health care organization
Average across comorbidity statuses	0.140 (.063)	0.152 (.025)
0 Comorbidities	0.115 (.113)	0.121 (.055)
1 Comorbidity	0.179 (.094)	0.197 (.040)
≥ 2 Comorbidities	0.279 (.054)	0.336 (.028)
Delivery system redesign
Average across comorbidity statuses	0.026 (.435)	0.102 (.066)
0 Comorbidities	0.043 (.124)	0.091 (.054)
1 Comorbidity	−0.007 (.906)	0.097 (.222)
≥ 2 Comorbidities	−0.016 (.907)	0.234 (.301)
Clinical information system
Average across comorbidity statuses	0.070 (.134)	−0.005 (.940)
0 Comorbidities	0.062 (.171)	0.011 (.830)
1 Comorbidity	0.050 (.533)	−0.038 (.670)
≥ 2 Comorbidities	0.247 (.284)	−0.024 (.924)
Decision support
Average across comorbidity statuses	−0.180 (.001)	−0.218 (.000)
0 Comorbidities	−0.194 (.001)	−0.248 (.000)
1 Comorbidity	−0.182 (.082)	−0.204 (.098)
≥ 2 Comorbidities	−0.063 (.797)	−0.015 (.947)
Self-management system
Average across comorbidity statuses	0.103 (.007)	0.149 (.011)
0 Comorbidities	0.129 (.001)	0.166 (.003)
1 Comorbidity	0.117 (.116)	0.160 (.101)
≥ 2 Comorbidities	−0.207 (.095)	−0.036 (.877)
Number of prescriptions^*
Health care organization
Average across comorbidity statuses	−0.001 (.991)	−0.001 (.985)
0 Comorbidities	−0.011 (.839)	−0.004 (.943)
1 Comorbidity	0.007 (.951)	0.011 (.916)
≥ 2 Comorbidities	−0.023 (.855)	−0.033 (.795)
Delivery system redesign
Average across comorbidity statuses	0.037 (.330)	0.160 (.015)
0 Comorbidities	0.036 (.368)	0.107 (.102)
1 Comorbidity	0.041 (.508)	0.263 (.008)
≥ 2 Comorbidities	0.101 (.179)	0.383 (.001)
Clinical information system
Average across comorbidity statuses	0.059 (.225)	0.010 (.879)
0 Comorbidities	0.048 (.375)	0.008 (.898)
1 Comorbidity	0.083 (.303)	0.049 (.615)
≥ 2 Comorbidities	0.035 (.737)	−0.077 (.534)
Decision support
Average across comorbidity statuses	0.012 (.816)	−0.101 (.089)
0 Comorbidities	0.087 (.133)	−0.060 (.328)
1 Comorbidity	−0.135 (.113)	−0.184 (.055)
≥ 2 Comorbidities	−0.194 (.026)	−0.205 (.077)
Diabetes mellitus
Number of prescriptions^*
Self-management system
Average across comorbidity statuses	−0.009 (.849)	0.054 (.412)
0 Comorbidities	−0.018 (.706)	0.090 (.192)
1 Comorbidity	−0.015 (.817)	−0.044 (.668)
≥ 2 Comorbidities	0.042 (.618)	−0.033 (.805)
Number of outpatient visits^*
Health care organization
Average across comorbidity statuses	0.160 (.108)	0.150 (.097)
0 Comorbidities	0.121 (.282)	0.125 (.228)
1 Comorbidity	0.175 (.098)	0.130 (.149)
≥ 2 Comorbidities	0.457 (.000)	0.452 (.000)
Delivery system redesign
Average across comorbidity statuses	0.063 (.132)	0.092 (.153)
0 Comorbidities	0.059 (.154)	0.080 (.251)
1 Comorbidity	0.080 (.101)	0.081 (.364)
≥ 2 Comorbidities	0.064 (.482)	0.325 (.019)
Clinical information system
Average across comorbidity statuses	−0.083 (.101)	−0.303 (.000)
0 Comorbidities	−0.064 (.211)	−0.316 (.000)
1 Comorbidity	−0.140 (.145)	−0.266 (.003)
≥ 2 Comorbidities	−0.024 (.842)	−0.258 (.063)
Decision support
Average across comorbidity statuses	−0.137 (.160)	−0.102 (.293)
0 Comorbidities	−0.162 (.174)	−0.144 (.229)
1 Comorbidity	−0.100 (.374)	−0.039 (.733)
≥ 2 Comorbidities	−0.084 (.478)	0.045 (.706)
Self-management system
Average across comorbidity statuses	0.085 (.047)	0.093 (.168)
0 Comorbidities	0.120 (.019)	0.128 (.088)
1 Comorbidity	0.059 (.315)	0.048 (.629)
≥ 2 Comorbidities	−0.156 (.034)	−0.144 (.306)
≥1 Inpatient admission^{^†}
Health care organization
Average across comorbidity statuses	0.021 (.253)	0.037 (.035)
0 Comorbidities	0.029 (.006)	0.034 (.000)
1 Comorbidity	0.035 (.460)	0.041 (.337)
≥ 2 Comorbidities	−0.077 (.434)	0.043 (.676)
Delivery system redesign
Average across comorbidity statuses	−0.003 (.749)	0.005 (.674)
0 Comorbidities	0.002 (.765)	0.009 (.469)
1 Comorbidity	−0.025 (.326)	−0.030 (.408)
≥ 2 Comorbidities	−0.005 (.951)	0.066 (.525)
Clinical information system
Average across comorbidity statuses	0.019 (.117)	0.004 (.758)
0 Comorbidities	−0.001 (.963)	−0.006 (.643)
1 Comorbidity	0.073 (.013)	0.027 (.291)
≥ 2 Comorbidities	0.068 (.501)	0.006 (.959)
Diabetes mellitus
≥1 Inpatient admission^{^†}
Decision support
Average across comorbidity statuses	−0.033 (.078)	−0.038 (.045)
0 Comorbidities	−0.035 (.041)	−0.024 (.175)
1 Comorbidity	−0.042 (.468)	−0.103 (.080)
≥ 2 Comorbidities	0.010 (.926)	0.017 (.869)
Self-management system
Average across comorbidity statuses	0.015 (.223)	0.017 (.283)
0 Comorbidities	0.024 (.020)	0.004 (.736)
1 Comorbidity	0.013 (.546)	0.104 (.015)
≥ 2 Comorbidities	−0.055 (.433)	−0.062 (.595)
≥1 Emergency department visit^{^†}
Health care organization
Average across comorbidity statuses	0.025 (.099)	0.027 (.068)
0 Comorbidities	0.016 (.160)	0.019 (.061)
1 Comorbidity	−0.002 (.959)	−0.005 (.885)
≥ 2 Comorbidities	0.228 (.006)	0.210 (.009)
Delivery system redesign
Average across comorbidity statuses	0.016 (.192)	−0.020 (.264)
0 Comorbidities	0.025 (.033)	−0.005 (.793)
1 Comorbidity	−0.009 (.755)	−0.078 (.038)
≥ 2 Comorbidities	−0.016 (.706)	0.004 (.939)
Clinical information system
Average across comorbidity statuses	0.014 (.296)	0.012 (.458)
0 Comorbidities	0.040 (.005)	0.015 (.283)
1 Comorbidity	−0.029 (.517)	0.040 (.346)
≥ 2 Comorbidities	−0.079 (.280)	−0.079 (.283)
Decision support
Average across comorbidity statuses	0.003 (.882)	0.020 (.386)
0 Comorbidities	−0.047 (.005)	−0.028 (.150)
1 Comorbidity	0.098 (.059)	0.124 (.028)
≥ 2 Comorbidities	0.114 (.210)	0.094 (.301)
Self-management system
Average across comorbidity statuses	−0.014 (.317)	0.009 (.653)
0 Comorbidities	−0.007 (.628)	0.013 (.563)
1 Comorbidity	−0.007 (.822)	−0.002 (.971)
≥ 2 Comorbidities	−0.093 (.065)	−0.007 (.926)
Cardiovascular disease
Total utilization^*
Health care organization
Average across comorbidity statuses	0.041 (.696)	0.003 (.976)
0 Comorbidities	0.056 (.733)	0.021 (.896)
1 Comorbidity	−0.029 (.778)	−0.042 (.663)
≥ 2 Comorbidities	0.231 (.413)	0.136 (.605)
Delivery system redesign
Average across comorbidity statuses	0.001 (.988)	−0.066 (.638)
0 Comorbidities	0.062 (.495)	−0.036 (.800)
1 Comorbidity	−0.098 (.262)	−0.321 (.157)
≥ 2 Comorbidities	0.055 (.741)	0.425 (.076)
Cardiovascular disease
Total utilization^*
Clinical information system
Average across comorbidity statuses	0.097 (.330)	0.065 (.601)
No comorbidities	0.105 (.351)	0.040 (.760)
One comorbidity	0.224 (.146)	0.339 (.055)
Two or more comorbidities	−0.191 (.450)	−0.354 (.082)
Decision support
Average across comorbidity statuses	0.013 (.923)	−0.003 (.982)
0 Comorbidities	−0.038 (.825)	−0.048 (.753)
1 Comorbidity	−0.079 (.680)	−0.142 (.467)
≥ 2 Comorbidities	0.197 (.516)	0.256 (.453)
Self-management system
Average across comorbidity statuses	−0.038 (.697)	−0.021 (.866)
0 Comorbidities	−0.093 (.482)	−0.112 (.474)
1 Comorbidity	0.142 (.279)	0.256 (.176)
≥ 2 Comorbidities	−0.221 (.335)	−0.355 (.298)
Number of prescriptions^*
Health care organization
Average across comorbidity statuses	−0.040 (.607)	−0.014 (.855)
0 Comorbidities	0.007 (.932)	0.004 (.956)
1 Comorbidity	−0.058 (.535)	−0.015 (.861)
≥ 2 Comorbidities	−0.216 (.025)	−0.154 (.110)
Delivery system redesign
Average across comorbidity statuses	−0.083 (.057)	−0.149 (.072)
0 Comorbidities	−0.180 (.001)	−0.267 (.008)
1 Comorbidity	−0.021 (.734)	−0.123 (.285)
≥ 2 Comorbidities	0.186 (.039)	0.273 (0036)
Clinical information system
Average across comorbidity statuses	0.215 (.004)	0.151 (.104)
0 Comorbidities	0.311 (.002)	0.152 (.201)
1 Comorbidity	0.131 (.155)	0.201 (.064)
≥ 2 Comorbidities	−0.148 (.449)	−0.004 (.981)
Decision support
Average across comorbidity statuses	−0.165 (.096)	−0.256 (.012)
0 Comorbidities	−0.196 (.127)	−0.366 (.005)
1 Comorbidity	−0.154 (.192)	−0.060 (.623)
≥ 2 Comorbidities	−0.033 (.884)	−0.146 (.524)
Self-management system
Average across comorbidity statuses	0.036 (.605)	0.184 (.052)
0 Comorbidities	0.068 (.413)	0.372 (.002)
1 Comorbidity	0.087 (.271)	−0.002 (.987)
≥ 2 Comorbidities	−0.155 (.213)	−0.261 (.217)
Number of outpatient visits^*
Health care organization
Average across comorbidity statuses	0.198 (.031)	0.057 (.486)
0 Comorbidities	0.290 (.017)	0.093 (.457)
1 Comorbidity	0.068 (.611)	−0.024 (.819)
≥ 2 Comorbidities	0.378 (.165)	0.348 (.184)
Cardiovascular disease
Number of outpatient visits^*
Delivery system redesign
Average across comorbidity statuses	0.009 (.895)	−0.141 (.209)
0 Comorbidities	0.006 (.947)	−0.137 (.280)
1 Comorbidity	−0.024 (.801)	−0.286 (.171)
≥ 2 Comorbidities	0.167 (.147)	0.242 (.106)
Clinical information system
Average across comorbidity statuses	0.006 (.964)	−0.020 (.866)
0 Comorbidities	0.010 (.945)	−0.055 (.710)
1 Comorbidity	0.080 (.609)	0.107 (.514)
≥ 2 Comorbidities	−0.205 (.393)	−0.118 (.464)
Decision support
Average across comorbidity statuses	−0.133 (.343)	−0.066 (.664)
0 Comorbidities	−0.092 (.560)	−0.022 (.902)
1 Comorbidity	−0.236 (.194)	−0.198 (.298)
≥ 2 Comorbidities	−0.191 (.485)	−0.082 (.783)
Self-management system
Average across comorbidity statuses	0.027 (.757)	0.036 (.770)
0 Comorbidities	0.000 (.999)	−0.044 (.760)
1 Comorbidity	0.155 (.156)	0.276 (.098)
≥ 2 Comorbidities	−0.145 (.376)	−0.319 (.249)
≥1 Inpatient admission^{^†}
Health care organization
Average across comorbidity statuses	−0.026 (.662)	−0.033 (.554)
0 Comorbidities	0.001 (.987)	0.003 (.964)
1 Comorbidity	−0.087 (.044)	−0.095 (.016)
≥ 2 Comorbidities	0.109 (.558)	0.102 (.580)
Delivery system redesign
Average across comorbidity statuses	0.003 (.890)	−0.011 (.821)
0 Comorbidities	0.045 (.127)	0.045 (.127)
1 Comorbidity	−0.057 (.083)	−0.057 (.083)
≥ 2 Comorbidities	0.018 (.804)	0.018 (.804)
Clinical information system
Average across comorbidity statuses	−0.013 (.713)	−0.001 (.986)
0 Comorbidities	−0.006 (.893)	0.004 (.932)
1 Comorbidity	0.044 (.388)	0.112 (.025)
≥ 2 Comorbidities	−0.089 (.359)	−0.185 (.042)
Decision support
Average across comorbidity statuses	0.081 (.067)	0.069 (.121)
0 Comorbidities	0.006 (.919)	0.014 (.785)
1 Comorbidity	0.124 (.050)	0.041 (.529)
≥ 2 Comorbidities	0.144 (.355)	0.219 (.191)
Self-management system
Average across comorbidity statuses	−0.027 (.476)	−0.042 (.353)
0 Comorbidities	−0.036 (.458)	−0.078 (.143)
1 Comorbidity	0.011 (.824)	0.074 (.306)
≥ 2 Comorbidities	−0.123 (.141)	−0.225 (.092)
Cardiovascular disease
≥1 Emergency department visit^{^†}
Health care organization
Average across comorbidity statuses	−0.008 (.928)	−0.013 (.873)
0 Comorbidities	−0.026 (.681)	0.020 (.744)
1 Comorbidity	0.011 (.855)	−0.024 (.682)
≥ 2 Comorbidities	0.104 (.727)	0.033 (.911)
Delivery system redesign
Average across comorbidity statuses	−0.041 (.068)	−0.017 (.641)
0 Comorbidities	−0.037 (.232)	−0.072 (.105)
1 Comorbidity	−0.039 (.215)	0.021 (.746)
≥ 2 Comorbidities	−0.042 (.685)	0.110 (.390)
Clinical information system
Average across comorbidity statuses	−0.040 (.332)	−0.032 (.479)
0 Comorbidities	0.027 (.522)	0.038 (.424)
1 Comorbidity	−0.083 (.234)	−0.040 (.536)
≥ 2 Comorbidities	−0.031 (.840)	−0.185 (.209)
Decision support
Average across comorbidity statuses	0.109 (.033)	0.105 (.032)
0 Comorbidities	−0.002 (.968)	0.015 (.763)
1 Comorbidity	0.182 (.002)	0.145 (.016)
≥ 2 Comorbidities	0.145 (.480)	0.149 (.497)
Self-management system
Average across comorbidity statuses	−0.027 (.497)	−0.041 (.428)
0 Comorbidities	−0.078 (.114)	−0.130 (.014)
1 Comorbidity	0.027 (.543)	0.060 (.431)
≥ 2 Comorbidities	−0.008 (.949)	0.083 (.690)

↵* Approximate percentage change (0.10 = 10%) in outcome variable when a clinic moves from early stage to intermediate- or late-stage transformation.
↵† Estimated percentage-point change (0.10 = 10 percentage points) in probability of outcome when a clinic moves from early stage to intermediate- or late-stage transformation.