Systematic Review Evaluates Patient-Centered Medical Home Model for Primary Care Transformation
The patient-centered medical home (PCMH) is a model of primary care transformation that seeks to meet the healthcare needs of patients and to improve patient and staff experiences, outcomes, safety, and system efficiency. As defined by physician and consumer groups, the core principles of the PCMH are: comprehensive, team-based care; patient-centered orientation toward the whole person; care that is coordinated across all elements of the healthcare system and the patient's community; enhanced access to care that uses alternative methods of communication; and a systems-based approach to quality and safety. Definitions of PCMH as implemented, however, vary widely, reflecting the rapid expansion of PCMH concepts in the last decade. Supported by the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to describe how studies conducted to date have implemented PCMH — and to evaluate the current evidence of the effect of PCMH interventions on patient, staff, and economic outcomes. Investigators conducted a review of the literature from database inception through June 29, 2012, identifying 60 articles representing 31 unique peer-reviewed studies that were used to answer the following questions: What individual PCMH components have been implemented? What financial models and implementation strategies have been used to support uptake? And, what are the effects of the PCMH on patient and staff experiences, process of care, clinical outcomes, and economic outcomes?
- There is moderately strong evidence that the patient-centered medical home has a small positive impact on patient experiences and small to moderate positive effects on delivery of preventive care services.
- Staff experiences are also improved by a small to moderate degree (low strength of evidence [SOE]), but no study reported effects on staff retention.
- Current evidence is insufficient to determine effects on clinical and most economic outcomes, with the exception of emergency department utilization, which was reduced among older adults (low SOE).
- Given the relatively small number of studies directly evaluating the PCMH, and the evolving approaches to designing and implementing the medical home model, the authors caution that these findings should be considered preliminary. The PCMH evidence base is expected to double in the next two to three years.
- Only one older study (1997) took place in VA, so results may not apply to the changes being implemented as part of the current Patient Aligned Care Team (PACT) initiative.
- There is no standard nomenclature for components of the PCMH model, and multiple definitions of the model have been proposed by various professional and patient organizations.
- Heterogeneity in study designs, populations, and outcomes in the studies examined in this review meant that standard quantitative summary methods were generally not possible.
Drs. Jackson, Powers, Dolor, and Williams are part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.
Jackson G, Powers B, Chatterjee R, Bettger J, Kemper A, Hasselblad V, Dolor R, Irvine R, Heidenfelder B, Kendrick A, Gray R, and Williams Jr., J. The Patient-Centered Medical Home: A Systematic Review. Annals of Internal Medicine November 27, 2012;e-pub ahead of print.