As we reported recently, enough medical home pilots are underway for some initial research to credibly report on early results. An article published in the American Journal of Managed Care contains a review of this early research. (AJMC Article) The medical home is focused on providing patients with a singular primary care point of contact which coordinates most or all of their care and takes responsibility for monitoring and maintaining a patient’s health. AHRQ commissioned the current study not only to evaluate the success of various medical home initiatives but to help guide those and future efforts by identifying what seems to be working or not working. The researchers only considered a program to be a PCMH if it met at least 3 of the 5 core criteria identified by AHRQ and found 14 evaluations which met their standards and which were included in the review.
There were three primary outcomes tested–cost, quality and patient experience. Five of the 14 studies examined all three of these; the rest looked at one or two. In terms of quality of care, there was one intervention that showed improved processes of care, two that showed improvement in health outcomes and none showed mortality benefits. In regard to costs, including the costs of the intervention, which can be significant for a PCMH, only one showed overall cost savings and those were quite modest. The others had net cost increases, although hospital utilization was reduced in some of the interventions and ER use may have been reduced in one. In regard to the patient experience of care, there appeared to be some improvement. The researchers caution that their results of modest improvement at best in most areas may be due to weak study designs and that ongoing and future evaluations of the PCMH need to use improved designs and methods to provide usable data.