Almost No Benefit of Medical Home Interventions in Community-Based Practices — Physician’s First Watch
Almost No Benefit of Medical Home Interventions in Community-Based Practices
By Thomas L. Schwenk, MD
The patient-centered medical home approach to primary care did little to improve utilization or quality-of-care measures in a JAMA study.
Thirty-two primary care practices in Pennsylvania who adopted a wide range of medical home features (e.g., performance feedback, disease-management registries) were compared with 29 control practices. Intervention practices achieved "medical home-ness" by the end of the 3-year study, as measured by standardized national criteria.
By study's end, intervention and control practices did not differ in ambulatory care-sensitive hospitalizations, emergency department use, primary care or specialist visits, or total cost of care. Only 1 of 11 quality-of-care measures (monitoring for diabetic nephropathy) was better in intervention practices.
These results will be discouraging to patient-centered medical-home advocates, but they might simply mean that the medical home is best deployed in a more concentrated approach for patients with costly conditions and high use and not as a generic way to care for broad populations of community-based primary care patients.
Dr. Schwenk is deputy editor of NEJM Journal Watch General Medicine, from which this story is adapted.