Improvements in quality of care and reductions in hospitalizations were minimal
Improvements in quality of care and reductions in hospitalizations were minimal, according to results from a three-year medical home pilot program carried out in 32 primary care practices and six health plans. In their report, researchers from the RAND Corporation also reported no reductions in emergency department visits or total costs of care.
Medical homes, sometimes called patient-centered medical homes, have been touted as a model that allows better access to health care, increases satisfaction with care, and improves health. It uses a team-based health care delivery model led by a physician, physician assistant, or nurse practitioner that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes.
How this model of care is adaptable to oncology practices remains to be seen, however, because the medical home model focuses on cancer prevention, screening, and coordination of care. For example, one study published in the June 2013 issue of Medical Care reported that of the Medicaid patients enrolled in Community Care of North Carolina, 40—85% received follow-up mammograms in accordance with guidelines and 95% of women received at least 2 physical examinations during the study period.
"The medical home has gained popularity as a new model of primary care, with the expectation that the approach will produce better and lower-cost health care," said Dr. Mark W. Friedberg, the study's lead author and a natural scientist at RAND, a nonprofit research organization. "Our findings suggest that achieving all of these goals is a challenge."
RAND researchers evaluated the Southeastern Pennsylvania Chronic Care Initiative. Using data from approximately 120,000 patients, researchers compared quality, utilization, and costs of care between the pilot practices and 29 other practices that were not in the pilot.
The RAND study found that pilot practices successfully adopted the medical home capabilities (such as creating lists of patients that were overdue for needed services) and achieved recognition as a medical home from the National Committee on Quality Assurance. Rates of monitoring for kidney disease among patients with diabetes improved, and there were signs that quality improved for some other aspects of diabetes care.
However, the evaluation of the medical home pilot did not detect improvements on the quality measures that assessed asthma care, cancer screening, and control of diabetes.
In addition, the medical home pilot did not show a reduction in patients' use of hospitals or emergency departments, or the total costs of medical care.