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Practice Characteristics and Outcomes

By February 27, 2012Commentary

There is a school of thought that believes that structuring a physician practice in a certain way will automatically mean better outcomes for patients.  The latest manifestation of this notion is the medical home concept, which is being piloted or implemented in a number of locations and which has been formalized by several groups, including the National Committee for Quality Accreditation.  A study published in Health Affairs examined whether there was any relationship between how well a group of Los Angeles community health centers met the NCQA requirements for a medical home and the outcomes the centers delivered for patients.   (HA Article)   The objective of medical home standards is to create a practice that, especially for chronic disease patients, uses evidence-based medicine to deliver continuous and coordinated care.  This study looked at diabetes care and sought to discern any correlation between a community health center’s score on the NCQA medical home standards and diabetes patients’ outcomes.  The thirty centers participating in the study self-assessed their performance on the nine NCQA domains.  The researchers then randomly selected 50 diabetes patients from each center and collected data on process of care and patient outcomes, largely using National Quality Forum diabetes care measures.

All the sites would have met the NCQA standards to be considered a medical home, with a range of scores from 33 to 90 and an average of 67.  A fairly high percentage of the diabetes patients had received Hb-A1c, cholesterol and blood pressure checks in the past year.  Just over half had received a kidney disease screening and about a third, an eye exam.  No significant association was found between a center’s score on the NCQA medical home standards and its performance on either process of care of intermediate patient quality outcomes.  This is contrary to the hypothesis that the higher the level of accredidation that a practice achieves as a medical home, the better its quality must be.  This is just another example of how the supposed quality measures used by both government programs and the private sector may not be doing such a good job of identifying true better outcomes.  It a

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