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Patient-centered medical home elements improve clinical quality

High performance on components of patient-centered medical homes, including continuity, access, care coordination and communication, enhance clinical quality and, if sustained, can lead to substantial health benefits to the population over time, according to research published in JAMA Internal Medicine.

“Despite widespread adoption of the patient-centered medical home (PCMH) model, it is unknown which components are most related to clinical quality,” Karin Nelson, MD, MSHS, from the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues wrote. “We sought to assess the association between elements of the PCMH model and clinical quality in the Veterans Health Administration’s (VHA’s) national PCMH initiative, the Patient Aligned Care Team (PACT) program.”

Nelson and colleagues used data from the External Peer Review Program of 48 clinical quality measures for chronic disease management and disease prevention. A total of 422,125 veterans who received primary care at one of 909 clinics between 2012 and 2014 were enrolled in the study. To measure the clinic-level PCMH implementation in 2012 for the included clinics, the researchers used the PACT Implementation Progress Index (Pi²) which consists of eight components: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision-making and team-based care.

Results indicated that clinics with higher scores on each of the eight components of Pi² performed better on clinical quality indicators. Care coordination, access, continuity and communication were most robustly associated with the clinic meeting more of the clinical quality indicators. High care coordination was associated with significantly better performance on 69% of the quality measures compared with low care coordination. Similarly, high access (67%), continuity (60%) and communication (52%) were associated with better performance.

When generalizing the data to the entire VHA primary care population (n = 5.4 million), the researchers found that if all clinics performed similarly to high-quartile clinics for care coordination, an additional 310,468 high-quality care services could have been delivered. Comparable results were seen for access, continuity and communication.

“We found that higher performance on each Pi² component favored improved clinical quality,” they concluded. “This was especially true for continuity, access, care coordination, and communication, which are hallmarks of effective primary care practice. Initiatives to improve primary care should focus on these important domains.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.