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- Title
The Patient-Centered Medical Home.
- Authors
Jackson, George L.; Powers, Benjamin J.; Chatterjee, Ranee; Bettger, Janet Prvu; Kemper, Alex R.; Hasselblad, Vic; Dolor, Rowena J.; Irvine, R. Julian; Heidenfelder, Brooke L.; Kendrick, Amy S.; Gray, Rebecca; Williams Jr., John W.
- Abstract
Background: The patient-centered medical home (PCMH) describes mechanisms for organizing primary care to provide highquality care across the full range of individuals' health care needs. It is being widely Implemented by provider organizations and thirdparty payers. Purpose: To describe approaches for PCMH implementation and summarize evidence for effects on patient and staff experiences, process of care, and clinical and economic outcomes. Data Sources: PubMed (through 6 December 2011), Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Database of Systematic Reviews (through 29 June 2012). Study Selection: English-language trials and longitudinal observational studies that met criteria for the PCMH, as defined by the Agency for Healthcare Research and Quality, and included populations with multiple conditions. Data Extraction: Information on study design, populations, interventions, comparators, financial models, implementation methods, outcomes, and risk of bias were abstracted by 1 investigator and verified by another. Data Synthesis: In 19 comparative studies, PCMH interventions had a small positive effect on patient experiences and small to moderate positive effects on the delivery of preventive care services (moderate strength of evidence). Staff experiences were also im-proved by a small to moderate degree (low strength of evidence). Evidence suggested a reduction In emergency department visits (risk ratio [RR], 0.81 [95% CI, 0.67 to 0.98]) but not in hospital admissions (RR, 0.96 [CI, 0.84 to 1.10]) in older adults (low strength of evidence). There was no evidence for overall cost savings. Limitation: Systematic review is challenging because of a lack of consistent definitions and nomenclature for PCMH. Conclusion: The PCMH holds promise for improving the experi-ences of patients and staff and potentially for improving care processes, but current evidence is insufficient to determine effects on clinical and most economic outcomes.
- Subjects
PATIENT-centered care; PUBLIC health; SYSTEMATIC reviews; EMERGENCY medicine; EMERGENCY medical services; HEALTH outcome assessment
- Publication
Annals of Internal Medicine, 2013, Vol 158, Issue 3, p169
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-158-3-201302050-00579