Anna D. Sinaiko, Mary Beth Landrum, David J. Meyers, Shehnaz Alidina, Daniel D. Maeng, Mark W. Friedberg, Lisa M. Kern, Alison M. Edwards, Signe Peterson Flieger, Patricia R. Houck, Pamela Peele, Robert J. Reid, Katharine McGraves-Lloyd, Karl Finison, and Meredith B. Rosenthal
A. D. Sinaiko, M. B. Landrum, D. J. Meyers et al., “Synthesis of Research on Patient-Centered Medical Homes Brings Systematic Differences into Relief,” Health Affairs, March 2017 36(3):500–8.
Despite widespread adoption of the patient-centered medical home (PCMH) model over the past decade, there is inconclusive scientific evidence about whether PCMHs lower costs or improve the quality of patient care. To better understand their impact, Commonwealth Fund–supported researchers conducted a meta-analysis for which they combined and standardized evaluation results from 11 major PCMH initiatives. The research team looked at outcomes for all patients in the study samples, as well as for a subgroup of patients with multiple chronic conditions.
On average, when evaluated as a group, the 11 PCMH initiatives did little to improve costs, utilization, or quality. Neither inpatient admissions nor emergency department visits declined for PCMH patients compared to study controls, and most quality metrics were unchanged.
The researchers did identify some improvement. Specialty visits declined by 1.5 percent for PCMH patients and cervical cancer screenings improved by 1.2 percent. Among higher-morbidity patients, total spending (net of pharmacy outlays) decreased by 4.2 percent and breast cancer screenings increased by 1.4 percent. However, only the breast cancer screening improvement remained significant after the researchers excluded from the meta-analysis an outlier PCMH that exhibited especially high improvement rates.
The observed variation in outcomes across the 11 PCMHs, together with inconsistent findings in previous research studies, suggests that “outcomes from PCMH initiatives vary significantly due to differences in their design and implementation,” the authors write. Further research, they say, could ascertain whether certain components of the model—whether coordination between primary care providers and specialists, integration of behavioral health care, or tracking and management of complex patients—contribute more to PCMH success than others.