Medical Home Pilot Project Reveals Mixed Results

Results from the National Demonstration Project (NDP), which tested patient-centered medical homes (PCMHs), have been published in the Annals of Family Medicine.  The American Academy of Family Physicians (AAFP) and the Commonwealth Fund started a test in 2006 to determine whether the NDP model can successfully be implemented.  The NDP model incorporates basic PCMH characteristics and components, and focuses on “implementing technological components, particularly more widely measured attributes such as use of electronic information technology or patient registries.”  More recently, the PCMH expanded the components to include easy access to first-contact care, comprehensive care, coordination of care, and personal relationships over time.

In conducting the study, examiners tested a diverse sample of 36 family practices from across the country.  The study suggested that “it is possible to build a PCMH even as the diverse, locally adopted meaning of a PCMH evolves.” However, in the short term, patients may perceive their care to be worse.  While it is unclear whether the NDP model will make a difference in quality of care, “[i]t is encouraging that the adoption of more NDP components was moderately associated with improvement on all 3 outcomes assessed in the medical record audit…”, which included ambulatory care, quality alliance measures, prevention, and chronic disease care.

The two-year study ended with very few practices successfully transforming into a PCMH, even with intense facilitation by the NDP.  This suggests that building a successful PCMH model requires a high level of motivation, communication, leadership, time, resources, and, in most cases, outside facilitation.

Click here for the results of the project.

Click here for AAFP’s Patient-Centered Medical Home Initiative information.