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- Title
A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices.
- Authors
Fifield, Judith; Forrest, Deborah; Martin-Peele, Melanie; Burleson, Joseph; Goyzueta, Jeanette; Fujimoto, Marco; Gillespie, William
- Abstract
BACKGROUND: Transition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices. OBJECTIVE: To test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2-10 providers) primary care practices over 2 years. DESIGN: Randomized Controlled Trial. PARTICIPANTS: Eighteen supported practices (intervention) and 14 control practices (controls). INTERVENTIONS: Intervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance's (NCQA) Physician Practice Connections ─Patient-Centered Medical Home™ (PPC-PCMH™) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC-PCMH™. MAIN MEASURES: PPC-PCMH™ at baseline and 18 months, plus intervention at 7 months. KEY RESULTS: At 18 months, 5 % of intervention practices and 79 % of control practices were not recognized by NCQA; 10 % of intervention practices and 7 % of controls achieved PPC-PCMH™ Level 1; 5 % of intervention practices and 0 % of controls achieved PPC-PCMH™ Level 2; and 80 % of intervention practices and 14 % of controls achieved PPC-PCMH™ Level 3. Intervention practices were 27 times more likely to improve PPC-PCMH™ by one level, irrespective of practice size ( p < 0.001) 95 % CI (5-157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect ( p = 0.01), which was twice as large as the sustained effect over subsequent 12 months ( p = 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC-PCMH™ standards over time ( p = 0.03). Intervention practices improved eight of nine standards, controls improved three of nine ( p = 0.009; p = 0.005 ; p = 0.007). CONCLUSIONS: Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.
- Subjects
PATIENT-centered care; MEDICAL practice; RANDOMIZED controlled trials; PHYSICIAN-patient relations; MEDICAL care costs
- Publication
JGIM: Journal of General Internal Medicine, 2013, Vol 28, Issue 6, p770
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-012-2197-z