Patient-Centered Medical Home Intervention Makes Some Progress

A patient-centered medical home (PCMH) intervention model emphasizing continuity, coordination and quality of care had favorable effects on patient and resident satisfaction but had no effects on emergency department or hospital use, according to a study by Michael E. Hochman, M.D., M.P.H., of AltaMed Health Services Corporation, Los Angeles.

Researchers implemented the intervention model at a teaching clinic with resident physicians and two similar clinics served as the control models. The effect on patient and resident satisfaction was measured using surveys. The intervention clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved, but it did not fully qualify as a PCMH, according to the results.

During the one-year study period, 4,676 patients were exposed to the intervention.

Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, the results indicate. For example, satisfaction with urgent appointment scheduling increased from 12 percent to 53 percent in the intervention clinic vs. from 14 percent to 18 percent in the control clinics. However, emergency department utilization did not differ between the intervention and control clinics, and hospitalizations increased in the intervention clinic vs. a decrease in the control clinics.

“Although our intervention fulfills only some elements of the PCMH model, our experience may be relevant to other teaching clinics, including those championing teaching health centers. Our findings also demonstrate the feasibility of quality-improvement efforts and system-based reforms in teaching settings,” the study concludes.

(JAMA Intern Med. Published online September 9, 2013. doi:10.1001/jamainternmed.2013.9241.