Evidence of medical home benefits lacking, researchers say

Patient-centered medical homes have inconsistent definitions
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Despite half of the country moving toward patient-centered medical homes (PCMH), the model might not improve clinical or economic outcomes.

A new review in the Annals of Internal Medicine found PCMHs positively affected the patient and staff experience, but it lacked sufficient evidence to show whether the model leads to better outcomes or economic benefits.

The researchers reviewed 19 comparative studies and noted that PCMH principles "hold promise" for enhancing care processes, especially for preventive services. But the review offered inconclusive findings, partly because of inconsistent definitions and nomenclature for PCMHs.

"Although implementing the PCMH principles is something to be considered by organizations seeking to enhance patient experience and quality of care, no menu is yet available for specific actions that are most likely to enhance benefits to patients, staff and organizations," the researchers wrote.

The review identified significant gaps in available evidence because most studies looked at the effects of PCMHs in chronically ill older adults and largely ignored pediatric or general adult primary care patients. The researchers also found an absence of PCMH data on staff retention and unintended consequences.

But some PCMH pilots are yielding positive preliminary results. For example, providers in Colorado saw lower emergency department (ED) visits and hospitalizations for chronically ill patients, thanks to its PCMH pilot. The PCMH also led to a whopping 250 percent to 400 percent return on investment for one payer participating in the demo project that ran from May 2009 through April 2012.

Meanwhile, Horizon Blue Cross Blue Shield of New Jersey's PCMH saw a 26 percent decline in ED visits and a 25 percent decrease in hospital readmissions in its first year.

The PCMH between Humana and Cincinnati‐based Queen City Physicians has shown similar positive results: a 34 percent decrease in ER visits, 10 percent improvement in diabetic management and 15 percent improvement in blood pressure control, FierceHealthPayer previously reported.

For more:
- read the review

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