Medical Homes and Patients with Chronic Diseases

Medical homes is one concept for improving primary care.  The basic idea is that a primary care physician will take responsibility for closely monitoring the health of his or her patients and coordinate and manage all the specialty and other care the patient receives.  Kind of what you might assume a primary care doctor was doing anyway, but apparently not always.  A somewhat rigorous framework of the capabilities and activities involved in being a medical home has been developed and practices can get certified.  The concept has been around for a few years and like a lot of health care concepts, has to some extent been bypassed by newer fads.  And the research on quality improvement or cost reductions didn’t often show dramatic positive changes in outcomes.  A recent study published in Health Services Research looked at quality effects of a medical home for patients with chronic diseases.   (HSR Article)   A large percentage of patients have at least one chronic condition and many of the most expensive patients have multiple chronic diseases.  Coordinating care for these patients is particularly important and the patient-centered medical home should be a method to enhance that coordination.

The authors used a patient-centered medical home model in North Carolina which covered over one million Medicaid recipients.  They looked at the care of adults aged 18 to 64 who had at least two of eight targeted chronic diseases, which included diabetes, asthma, hypertension, high lipid levels, major depression, schizophrenia and chronic obstructive pulmonary disease.  The researchers looked at some standard quality measures, primarily process ones, associated with these diseases and compared results for the medical home patients versus those not in a medical home practice.  The medical home patients were more likely to receive all but one of the recommended services than the non-medical home patients, but also experienced more over-use of one non-recommended treatment.  In general, the medical home patients received more care that was consistent with guidelines.  Some of the increases were fairly large.   Caution should be noted in regard to the findings, however, because these process measures may or may not actually be correlated with improvements in primary health outcomes.  And the authors did no economic analyses.  Being a medical home and delivering these recommended services costs something.  It is useful to know if the benefits outweigh the costs.