- A VA initiative to implement patient-centered medical homes (PCMHs) across the country has resulted in better chronic care management for patients, according to research from the University of Pittsburgh Medical Center.
The study looked at a VA-sponsored PCMH initiative titled the Patient Aligned Care Teams (PACT) program. The program launched in 2010 and was the largest of its kind at the time. PACT introduced PCMH principles to over 800 clinics.
Each participating clinic had equal access to resources and education about the PACT model. The model emphasized key aspects of patient engagement and patient-centered care, including patient access, continuity, coordination, team-based care, comprehensiveness of care, self-management support, patient-centered communication and shared decision-making.
The research team, led by University of Pittsburgh School of Medicine associate professor Ann-Marie Rosland, MD, sought to assess the impact of PCMH models on chronic care management. Rosland is also a part of the VA Pittsburgh Center for Health Equity Research and Promotion.
Rosland and her team looked at seven care outcomes measures and eight process measures for coronary artery disease, diabetes, and hypertension. These are three common chronic illness that, when left untreated, accrue significant health costs and negative outcomes.
Although the researchers did not assess a control practice, some organizations adopted more of the PCMH tenets than others did. This revealed ranks of top and bottom performers that the researchers compared.
The researchers ultimately compared the 77 clinics that had embraced the most PCMH principles and the 69 clinics that had adopted the fewest PCMH principles.
The top tier PCMH group outperformed on five of seven outcomes measures compared to the other practices, the researchers found. More advanced PCMH practices saw 1 to 5 percent more patients meeting care metrics for diabetes, blood pressure, and cholesterol control, the researchers reported.
These findings are novel, Rosland said in a statement. Although healthcare professionals have lauded the PCMH model as effective in delivering high-quality and patient-centered care, they have yet to look at the outcomes and process measures that can confirm the utility of the PCMH model.
“Most studies of comprehensive medical home models have not been able to assess the impact they have on the control of chronic conditions, such as whether patients are bringing their sugar levels down to recommended goals,” said Rosland.
Previous PCMH research has largely looked at whether doctors and other clinicians have followed PCMH process, such as whether they are checking sugar levels, Rosland added.
“All VHA primary care patients were provided with PACT’s team-based care, and we were able to identify that this model of care, when well-implemented, translated into better outcomes for patients with chronic conditions,” Rosland stated, noting that this current study looks at whether those processes have an impact on chronic care.
Not all clinical measures saw improvements following PACT model implementation, Rosland and team conceded. Top performing clinics only saw improvements in two of the eight tested process measures, for example. The study results nonetheless suggest the PACT model, which leverages strong PCMH principles, is promising.
“While not every clinical measure improved as significantly as others with increased implementation of the PACT model, this study demonstrates that health systems that invest in changes in care delivery through a medical home model for all primary care patients could see downstream improvements in the management of those patients with chronic diseases,” Rosland explained.
Other studies have looked at how funding affects PCMH efficacy. A 2017 report from the RAND Corporation found that federally-qualified health centers (FQHCs) receiving financial support from CMS were more likely to achieve higher PCMH distinction than clinics that did not receive funding.
Seventy percent of FQHCs receiving PCMH funding were able to achieve full PCMH distinction, while only 11 percent of FQHCs not receiving funding achieved the same.
As a result, clinics receiving financial support were able to expand patient care access, deliver more coordinated care, and practice more patient-centered care strategies.
These improvements may result in overall better care quality for traditionally underserved patient populations, RAND researcher Justin Timbie said in a public statement.
"Primary care medical practices are rapidly adopting the patient-centered medical home model of care and one result may be that under-served patients use more services once it becomes easier to access care," Timbie concluded. "There also is evidence that improvements in primary care may lead to reductions in specialty care and cost over a longer period than we examined in this study."