Skip to main content

Review of Medical Home Evidence

By December 27, 2012Commentary

We know that we are constantly expressing skepticism about all the “innovations” in health care which are supposed to make the system work so much better.  But the evidence rarely finds the value in the innovation that proponents claim for it.  The patient-centered medical home is a delivery system approach which is supposed to ensure better quality by focusing on the patient’s needs and coordinating care across providers.  A comprehensive review in the Annals of Internal Medicine attempted to ascertain the effects of this new delivery model.   (Annals Article)   The researchers were hindered by a lack of consistency in definition or operation of a “medical home” and by the usual paucity of high-quality research.  They ended up with about 30 studies that they deemed relevant and trustworthy.  It was hard to identify which components of the medical home might have been responsible for specific outcomes.

The researchers found some evidence that the medical home format created at least short-term improvements in patient and staff experiences.  The evidence was stronger in regard to patients, who reported small increases in overall satisfaction and in perceptions of care coordination.  There was also evidence that at least process of care quality measures showed improvement in medical home practices, particularly for patients with chronic illnesses.  But in terms of actual clinical outcomes, such as those reflected by biophysical markers or mortality, there was little evidence of improvement.  In regard to economic outcomes, the researchers did not see evidence of consistently lower utilization, either in emergency room visits or inpatient hospital days.  Nor was there strong evidence of overall lower costs for patients treated in these practices.  Given the relatively short period of time that these models have been in use and the possibility, if not likelihood, that patient exposure to these models over a longer period may have stronger effects, there is no reason to be discouraged, but so far, there is also good reason to be skeptical.

Leave a comment