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Almost No Benefit of Medical Home Interventions in Community-Based Practices — Physician’s First Watch

Medical News |
February 26, 2014

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.

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