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Journal Article


Quality and Efficiency in Small Practices Transitioning to Patient-Centered Medical Homes: A Randomized Trial

The Issue

Patient-centered medical homes offer the promise of reducing health care costs while increasing quality and improving patients’ experiences. There is growing evidence that small and even solo primary care practices can successfully make the transition to become medical homes when given the necessary supports. Still, despite their promise, studies have been inconclusive about medical homes’ effect on health care costs or quality and efficiency improvements, such as reducing emergency room use.

What the Study Found

In this Commonwealth Fund–supported study, researchers compared two groups of small primary care practices that serve a general adult population and were transitioning to the medical home model. Eighteen intervention practices with 43 physicians received support in the form of practice redesign, including help with electronic health records and workflow; on-site nurse care managers, who helped coordinate patients’ care; and enhanced payment, including pay-for-performance incentives. The 14 control practices with 24 physicians were left to make the transition primarily on their own.

During the study period (January 2008 to December 2010), the intervention practices rapidly made the transition to patient-centered medical homes while control practices lagged. Benefits were modest: of 11 clinical measures, high blood pressure control improved by 23 percent and breast cancer screening by 3.5 percent in the intervention practices. In addition, there was a reduction of 3.8 emergency department visits per physician per year, saving approximately $1,900 per physician. Yet overall, the researchers did not find significant cost savings.


Providing small primary care practices with supports that include more robust electronic health records, on-site care managers, and increased reimbursement helps them become medical homes. However, unanswered questions remain about how the model can be enhanced to obtain more significant cost savings without sacrificing quality

Publication Details



J. Fifield, D. D. Forrest, J. A. Burleson et al., "Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial," Journal of General Internal Medicine, published online March 2, 2013.