Beneficial Outcomes of Implementing PCMH Take Time

July 13, 2012

The Patient-Centered Medical Home is touted as a way to improve care coordination, quality, and patient experience, while reducing costs. But how quickly?

Most advocates for the Patient-Centered Medical Home (PCMH) model of care believe it improves patient outcomes and patient satisfaction while reducing healthcare costs.

But a new study published in the journal Health Services Research suggests that at least one of those claims may be premature.

Researches asked nearly 400 practices if they had implemented PCMH-like processes, such as care coordination, EHRs, clinical decision support, quality measurement, e-mail access, and group visits, according to American Medical News.

The patients surveyed at these practices reported similar experiences and perceptions of care, regardless of whether their practice had implemented PCMH-like processes.

This is especially surprising considering that the new model of care focuses on improving the physician-patient relationship through things like goal setting, patient outreach, and patient follow up.

Why the disconnect? Katherine Browne, deputy director of Aligning Forces for Quality, told American Medical News that the transition to a medical home takes some time.

“The work flow, processes and all that don’t change overnight,” she said. “It’s not as though one day they’re not a patient-centered medical home and the next day they are, and instantaneously all the care has changed. The effects of the redesign of care and the changing of those processes and changes in culture may not have been felt by patients.”

In fact, a study published in the Annals of Family Medicine in 2011 found that it might take some time for patients to recognize - and feel the effects - of the PCMH transition.

The study looked at a group of 21 Minnesota primary-care clinics who had achieved level III recognition as medical homes by the National Committee for Quality Assurance. While patient satisfaction improved at the clinics, it improved only one percent to three percent each year of participation.

“Achieving medical home recognition was associated with improvements in quality and patient satisfaction for these clinics, but the rate of improvement is slow and does not always exceed levels in the surrounding community in Minnesota (which are also improving),” the researchers concluded. “Expectations for large and rapid change are probably unrealistic.”

Another reason for the lack of rapid change in patient experience could simply be attributed to the patients themselves. Many may be resistant to change at their practices. For instance, they may have difficulty adjusting to physicians using EHRs in exam rooms, or different staff members taking on different roles, etc. 

Still, many other studies and healthcare organizations that have adopted the PCMH model report more rapid positive results

Group Health Collaborative of Puget Sound, for instance, piloted a PCMH program at one of its Seattle clinics in 2007. The pilot clinic had “significantly greater” improvement on measures of patient experiences after one year when compared to 19 other group health sites that had not participated in the pilot, according to the Patient-Centered Primary Care Collaborative.

Have you or transitioned your practice into a Patient-Centered Medical Home model? How has it influenced your patients’ perceptions of their care? Are you seeing any significant impact?