In a novel approach to test the merits of the patient-centered medical home model, research published today in the Annals of Internal Medicine concludes these practices improve care quality at a significantly higher rate than their non-PCMH peers—regardless of whether the comparison practices used paper or electronic health records. The three-year study also found the odds of patients receiving recommended care over time in the medical home were considerably higher.
The paper, “The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care,” sheds new light on the effectiveness of the PCMH. Lead author Lisa Kern, MD, MPH, of Weill Cornell Medical College and her colleagues followed 675 primary care providers in three groups over the study period—representing medical homes, paper-based non-medical homes and EHR-based non-medical homes—to test their progress improvement on 10 industry-recognized primary care quality measures. The study was funded by the Commonwealth Fund and the New York State Department of Health
Significantly, the study examines PCMH practices of varying sizes and types—from large group practices to small, solo practices and federally-qualified health centers—in an open medical community, without a large integrated health system. Findings can be applied across varying independent practice types.
Researchers teased out the differences in quality along several lines:
“These results demonstrate that you’re going to get better quality of care if you see a provider that’s part of a patient-centered medical home. That’s a big deal for patients and purchasers of care,” said Susan Stuard, THINC’s executive director. “It helps us understand more about the mark of quality you find in these practices. You’re 7 percent more likely to get the recommended care you need. And that’s powerful.”
This study took place in the Hudson Valley of New York. The 15 medical home practices—all EHR users–were involved in previous work with the Hudson Valley Initiative, a community-wide effort that seeks to transform health care delivery through health information technology, practice transformation, and value-based purchasing. The initiative combines the work of the Taconic Health Information Network and Community (THINC), the Taconic Independent Practice Association and MedAllies.
In 2009, THINC convened six health plans, covering approximately 70 percent of the community’s commercially insured population. The plans agreed on a set of 10 quality measures, and to provide financial incentives totaling more than $1.5 million to practices that implemented the medical home model as defined by the National Committee for Quality Assurance (NCQA) standards, at Level 3 (the highest level).
Researchers noted the collaborative nature of the Hudson Valley Initiative effort to support the practices as they evolved to the PCMH model. The practices were assisted by Taconic IPA and participated in structured, monthly meetings where lead physicians from each practice shared questions, challenges and experiences.
“The quality markers tracked in this study show that a practice like my own–a small practice—can achieve better quality in a collaborative environment,” said Eugene P. Heslin, MD, lead physician, Bridge Street Medical Group in Saugerties, one of the medical home practices participating in the study. “The focused convening we did, where people who usually compete against each other are able to work together to improve outcomes for patients on a community-wide basis —helped us all succeed. We have a measurable, process-driven way to care for patients, and that gives us better outcomes.”
Stuard estimates more than half a million patients in the Hudson Valley are in medical home practices today.
“We’re showing that the PCMH is not just a process, it’s about better outcomes,” she said. “It is absolutely worth the time, money and energy invested in creating better primary care practices. The PCMH designation shows that you put in enough training so you can run that marathon and cross the finish line. From this study in the Hudson Valley, practices know that marathon-running capability results in better care.”
For Frequently Asked Questions about the study, click https://origin.library.constantcontact.com/doc202/1101292888704/doc/UlNpFoEJt3jVf1R2.pdf.
About the Taconic Health Information Network and Community (THINC)
THINC is dedicated to improving the quality, safety and efficiency of health care for the benefit of the people of the Hudson Valley region of New York. The primary purpose of THINC is to advance the use of health IT through the sponsorship of a secure health information exchange network, the adoption and use of interoperable EHRs and the implementation of population health improvement activities. These activities include public health surveillance and reporting, pay for performance, patient centered medical home practice transformation, care coordination activities, public reporting, and other quality improvement initiatives. For more information, go to www.THINC.org. THINC is part of the Hudson Valley Initiative, an effort to revolutionize health care delivery through a shared vision to improve the quality, safety and efficiency of health care in the community. To learn more, go to http://www.hudsonvalleyinitiative.com.
