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Advanced Primary Care Clinic outcomes

  • 2014 outcomes

    The Courage Kenny Advanced Primary Care Clinic demonstrates that excellent primary care can improve clients’ health and health care experiences, reduce hospitalizations, and lower health care costs. The Advanced Primary Care Clinic is a state-certified medical home where clients are managed by a team of health care professionals. On average, clients have 66% fewer hospital days after enrolling in the clinic, and the average number of days spent in the hospital each year for each client drops from 10.6 days to 3.6 days. We estimate this lowers costs by an average of $1,277 per client per month.


    In 2014, the Courage Kenny Advanced Primary Care Clinic served 248 clients.

    Age of clients served by Advanced Primary Care Clinic - 2014

    Race of clients served by Advanced Primary Care Clinic - 2014

    Diagnoses of clients served by Advanced Primary Care Clinic - 2014

    Health care providers of clients served by Advanced Primary Care Clinic - 2014

    Client outcomes

    The measures used to determine the impact of the Advanced Primary Care Clinic on patient outcomes include:

    • Healthy Days: a measure the client’s of overall health estimated through the client’s response to how many days he or she had poor physical or mental health over the past 30 days.
    • Patient Health Questionnaire-9 (PHQ-9): a clinical tool that is used to screen for depression
    • Patient Activation Measure (PAM): a measure of the client’s skills, knowledge, and confidence in taking an active role in maintaining his or her health
    • Secondary Conditions Surveillance Instrument: determines the number and severity of secondary conditions
    • Number of hospitalizations and length of stay per hospitalization

    Healthy days chart - Advanced Primary Care Clinic 2014

    Healthy days

    The median number of healthy days at enrollment for all clients of the clinic was 18 days. After one year, the median increased to 20 days, indicating that overall, clients made gains in their health status. Clients with Medicare or who were dually insured by both Medicaid and Medicare insurance (also known as “duals”), reported the greatest improvements in healthy days with an average increase of four days.


    After one year of receiving clinic services, the median PHQ-9 score for all clients of the clinic dropped minimally from a score of 5.1 to 5.0. Clients with Medicare insurance had the greatest decrease in scores from 6.5 points to 5.0 points. Decreased scores indicate improvements in depression. 

    APC clinic 2014 - change in PHQ 9 scores

    Patient activation

    The median Patient Activation Measure (PAM) score at enrollment for all clients of the clinic did not change at the one-year mark of receiving clinic services. At enrollment and after one year of services, median PAM scores remained at 63 points. This score indicates that clients were moderately activated and empowered to take action in managing their health but were not confident that they would maintain newly adopted health behaviors.

    Clients with Medicaid (or Medical Assistance) had the greatest improvement in PAM scores after one year in the clinic, going from an initial score of 56 to 64 points. These clients grew in skills, knowledge, and confidence to manage their own health. 

    Change in PAM scores 2- APC clinic 2014

    Secondary conditions

    The average number of health conditions reported by clients was eight conditions. The five most common conditions reported by clients were pain (59%), fatigue (58%), anxiety (53%), joint pain (53%), and problems with memory (53%).

    APC Clinic - Secondary conditions chart 2014


    Courage Kenny Rehabilitation Institute has a data-sharing agreement with the Minnesota Department of Human Services that allows for the tracking of hospitalizations and emergency department visits for the clinic’s Medicaid-insured clients before and after their enrollment in the clinic.

    Health care utilization data was collected for 157 clients with of the Advanced Primary Care Clinic with Medicaid insurance. As of December 2014 the average hospitalization rate for this group was:

    • 10.6 days per year PRIOR to enrollment
    • 3.6 days per year AFTER enrollment

    On average, clients had fewer hospitalizations after enrolling in the clinic, indicating improved or maintained health, or better access to their primary care team. The difference equates to a 66% reduction in hospital days, or a savings of $1,277 per Medicaid or dually-eligible client per month, which totals to $2.4 million for all Medicaid or dually-eligible clients for the year. 

    For more information on outcomes, please call 612-775-2510. For more information about the Advanced Primary Care Clinic, please call 612-775-2600.