The Patient-Centered Medical
Home
July 2012
In 2004, AHRQ launched a collection of evidence reports, Closing the Quality Gap: A
Critical Analysis of Quality Improvement Strategies, to bring data to bear on quality
improvement opportunities. These reports summarized the evidence on quality improvement
strategies related to chronic conditions, practice areas, and cross-cutting priorities.
This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of
the Science. This report was commissioned to
identify completed and ongoing efforts to evaluate the comprehensive patient-centered medical home (PCMH) model, summarize
current evidence for this model, and identify gaps in the evidence.
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Structured Abstract
Objectives: As part of the Closing the Quality Gap: Revisiting the State of the Science series of
the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to
identify completed and ongoing evaluations of the comprehensive patient-centered medical home
(PCMH), summarize current evidence for this model, and identify evidence gaps.
Data Sources: We searched PubMed®, CINAHL®, and the Cochrane Database of Systematic
Reviews for published English-language studies, and a wide variety of databases and Web
resources to identify ongoing or recently completed studies.
Review Methods: Two investigators per study screened abstracts and full-text articles for
inclusion, abstracted data, and performed quality ratings and evidence grading. Our functional
definition of PCMH was based on the definition used by AHRQ. We included studies that
explicitly claimed to be evaluating PCMH and those that did not but which met our functional
definition.
Results: Seventeen studies with comparison groups evaluated the effects of PCMH (Key
Question [KQ] 1). Older adults in the United States were the most commonly studied population
(8 of 17 studies). PCMH interventions had a small positive impact on patient experiences
(including patient-perceived care coordination) and small to moderate positive effects on
preventive care services (moderate strength of evidence [SOE]). Staff experiences were also
improved by a small to moderate degree (low SOE). There were too few studies to estimate
effects on clinical or most economic outcomes.
Twenty-one of 27 studies reported approaches that addressed all 7 major PCMH components
(KQ 2), including team-based care, sustained partnership, reorganized care or structural changes
to care, enhanced access, coordinated care, comprehensive care, and a systems-based approach to
quality. A total of 51 strategies were used to address the 7 major PCMH components.
Twenty-two of 27 studies reported information on financial systems used to implement
PCMH, implementation strategies, and/or organizational learning strategies for implementing
PCMH (KQ 3).
The 31 studies identified in the horizon scan of ongoing PCMH studies (KQ 4) were broadly
representative of the U.S. health care system, both in geography and in the complexity of private
and public health care payers and delivery networks.
Conclusions: Published studies of PCMH interventions often have similar broad elements, but
precise components of care varied widely. The PCMH holds promise for improving the
experiences of patients and staff, and potentially for improving care processes. However, current
evidence is insufficient to determine effects on clinical and most economic outcomes. Ongoing
studies identified through the horizon scan have potential to greatly expand the evidence base
relating to PCMH.
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Closing the Quality Gap: Revisiting the State of the Science Series: The Patient-Centered Medical Home.
Evidence-based Practice Center: Duke EPC
Current as of July 2012
Internet Citation:
Closing the Quality Gap: Revisiting the State of the Science Series: The Patient-Centered Medical Home. Structured Abstract, July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/gappcmhtp.htm