Thursday, February 14, 2013

Patient Centered Medical Homes: Do They Work?

In a prior blog entry, it was noted that over-use of the Emergency Room may be facilitated by the implementation of “patient centered medical homes” (PCMH). A PCMH is a team-centered health care system led by a medical doctor, nurse practitioner, or physician assistant to provide comprehensive and continuous health care.

In the PCMH model, two or more clinicians work together to coordinate health care. The PCMH model is designed to do two or more of the following: a) provided enhanced access to care (e.g., 24-hour coverage), b) coordinated care, c) comprehensive care (i.e., can take care of most of a person’s medical needs), and d) uses a systems-based approach to improve quality and safety. The PCMH model is designed to develop a sustained relationship with the patient and reorganizes traditional health care delivery practices.

At present, there are not many medical homes in the U.S., but the numbers will expand greatly as part of health care reform. While PCMHs are often said to have great promise, is there evidence that they actually work to improve most clinical outcomes (e.g., improved management of health conditions) and economic outcomes (e.g., decreased healthcare costs)?

In a recent article in the Annals of Internal Medicine, researchers examined 19 comparative studies to determine the effectiveness of PCMH interventions.  The results were less than stellar. Specifically, there was no evidence that the PCMH model reduced overall medical costs. There was a small positive effect on patient experiences and a small to moderate effect on the delivery of preventive care experiences.  Staff experiences were improved by a mild to moderate degree. While the study showed that there was a reduction in ER visits, consistent with what was suggested earlier, admissions to the hospital were not decreased for older adults. The authors concluded that the PCMH model holds promise but that the current evidence is insufficient regarding its effective on clinical outcomes and most health outcomes. 

Suggested reading: ObamaCare Survival Guide
Reference: Jackson, G., et al. (2013). The Patient Centered Medical Home: A Systematic Review. Annals of Internal Medicine. 158, 169-178.

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