NEW YORK (Reuters Health) - Implementation of a patient-centered medical home (PCMH) resulted in small changes in utilization patterns and modest quality improvements over a three-year period, according to a new report.
Dr. Lisa M. Kern of Weill Cornell Medical College in New York City and colleagues found more primary care visits, fewer specialist visits, fewer lab and radiologic tests, and fewer hospitalizations and rehospitalizations in the practices that adopted the PCMH.
Most changes occurred in the last year of the study, three years after PCMH implementation, they report in the Annals of Internal Medicine, online February 15.
The PCMH model "attempts to shift the medical paradigm from care for individual patients to care for populations, from care by physicians to care by a team of providers, from a focus on acute illness to an emphasis on chronic disease management, and from care at a single site to coordinated care across providers and settings," Dr. Kern and her team write. However, they add, studies looking at the effectiveness of the approach have had mixed results.
To date, most studies attempting to look at PCMH have had follow-up periods lasting just 1.5 to 2 years after implementation, the researchers note. "These changes take time, and studies with relatively short follow-up may have underestimated the effects of the intervention," they add.
The new study included 438 primary care physicians in 226 practices with more than 136,000 patients enrolled in five health plans. Insurers offered incentives of $2 to $10 per patient per month to practices that achieved level III PCMH recognition from the National Committee for Quality Assurance
Twelve practices including 125 physicians volunteered for the PCMH initiative, and were assisted by two outside consulting groups. All of these practices achieved level III PCMH recognition. Among the remaining physicians, 87 doctors in 45 practices adopted electronic health records (EHR) without the
PCMH intervention, and 226 physicians in 169 practices continued using paper records.
For the eight quality measures the researchers looked at, two showed greater improvements over time in the PCMH group compared to one or both of the control groups: eye examination and hemoglobin A1c testing for patients with diabetes.
From 2008 to 2012, the PCMH group showed improvements over the paper group and the EHR group for six of seven utilization measures.
NCQA recognition was one aspect of the PCMH intervention in the new study, but this doesn't represent the entire intervention, Dr. Mark W. Friedberg of RAND Corporation and Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the study, told Reuters Health.
"What they evaluated was a different way of paying practices, combined with some technical assistance, combined with some shared savings in the last year of the pilot," Dr. Friedberg explained. And this also requires defining what improving care means, he added, for example "better technical quality of care, better patient experience, better effectiveness of care, better professional satisfaction and lower burnout for people working in the practices. It's also hard to measure all of those, and most studies don't."
The new study is well done, according to Dr. Friedberg, but the challenge will be to understand how it fits in with the rest of the medical home literature, he said. "There's a lot of trials still out there and the results are still coming in, including some very large Medicare medical home pilots. I think we'll have a much better sense of what works in a year or two as those results come back."
Dr. Kern did not respond to an interview request by press time.
The study was funded by The Commonwealth Fund and the New York State Department of Health.