By Matt Kuhrt
Patient-centered medical homes (PCMH) have shown promise among alternative healthcare provision models aimed at improving quality of care. But a new study published in the Annals of Internal Medicine offers the clearest view yet of the potential benefits of the model, while also raising questions about some of the benefits seen in previous analyses.
PCMHs include a team of providers in a network to improve access to care and coordination among providers. The high startup costs required for such an entity make solid outcome data important, and previous studies have offered variable, sometimes conflicting results, according to an article in Medscape. Indeed, in a commentary that accompanies the study, Mark W. Friedberg, M.D., of RAND Corporation, said that it's important to have a consistent definition of a medical home.
The new study looked at 438 primary care physicians in 226 practices, with 136 480 patients across five health plans. It also features a longer duration than most previous research, with three years of follow-up for a five-year duration all told. It also uses the National Committee for Quality Assurance's level 3 PCMH definition, in order to produce more comparable results.
The research showed modest gains in primary care visits and fewer hospitalizations in the three-year period after implementation of the PCMH model. Since the beneficial changes in use of care took place in the last year of the study, the authors are unsure whether they were necessarily caused by the program itself, or whether they represent a statistical outlier, suggesting further studies will be necessary to explain the findings.
The authors were also puzzled by the discovery that emergency department visits remained unchanged over time, since other studies have demonstrated a reduction in such visits. "It is plausible that hospitalizations and rehospitalizations could have been averted, without a change in ED visits, through improved care coordination in the ambulatory setting," they write.