Primary Care

Although the patient-centered medical home is a promising model of care, more studies are needed to assess its effectiveness

Although the patient-centered medical home (PCMH) is a promising model of care, rigorous evaluations and analysis are needed to assess its effectiveness and refine the model to meet stakeholders' needs, concludes a review of studies on the topic. Most (93 percent) health care consumers want to have a single place or doctor to provide primary care and coordinate with any specialists. However, only half report having such an experience, according to recent surveys. Decisionmakers are aware of consumers' interest, but need to consider whether the evidence supports investing in restructuring care to the PCMH model to achieve better quality, improved experience, and lower cost of care.

Researchers at the Agency for Healthcare Research and Quality (AHRQ), Janice L. Genevro, Ph.D., Michael L. Parchman, M.D., and David S. Meyers, M.D., along with colleagues from Mathematic Policy Research, conducted the literature review of 498 studies published or disseminated from January 2000 to September 2010. Of these, 14 evaluations of 12 interventions were judged to be rigorous. The interventions most often cited to support the medical home were viewed as precursors to the medical home. Evaluation of six of these interventions provided rigorous evidence on at least one of the three outcome areas: quality, cost and service use, and experience of care.

Overall, the evidence on the PCMH provides some favorable effects on all of the outcomes of interest and a few unfavorable effects on costs. Yet, most results were inconclusive. Further, most of the existing interventions targeted older, sicker populations, who showed more favorable effects that did general populations. The study was funded by the Agency for Healthcare Research and Quality (Contract No. 290-09-000191).

More details are in "Early evaluations of the medical home: Building on a promising start," by Deborah Peikes, Ph.D., Aparajita Zutshi, Ph.D., Janice L. Genevro, Ph.D., and others in the February 2012 American Journal of Managed Care 18(2), pp. 105-116. Reprints (Publication No. 12-R032) are available from the AHRQ Publications Clearinghouse.

— DIL

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