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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 6/2010

Open Access 01-06-2010 | Original Article

Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home: A Focus on Outcomes

Authors: Diane R. Rittenhouse, MD, MPH, David H. Thom, MD, PhD, MPH, Julie A. Schmittdiel, PhD

Published in: Journal of General Internal Medicine | Issue 6/2010

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Abstract

Background

The Patient-Centered Medical Home (PCMH) is a widely endorsed model of delivery system reform that emphasizes primary care. Pilot demonstration projects are underway in many states, sponsored by Medicare, Medicaid, major health plans and multi-payer coalitions.

Methods

In this paper we consider the development of a long-term policy-relevant research agenda on outcomes of the PCMH. We provide an overview of potential measures of PCMH impact, identify measurement challenges and recommend areas for further study. Although the PCMH should not be expected to solve every problem in the health care system, developing a research agenda for measuring outcomes of delivery system innovations such as the PCMH should be considered in the context of the larger effort to improve the US health care system, with the ultimate goal to improve population health.

Results

As a framework for our discussion, we have chosen the Institute of Medicine’s six specific aims for 21st century health care: (1) safe, (2) effective, (3) patient-centered, (4) timely, (5) efficient and (6) equitable. In addition, we include potential areas of PCMH outcomes that do not easily fall under this framework and consider unintended consequences.

Conclusion

Multi-stakeholder involvement will be essential in developing a long-term policy-relevant research agenda for outcomes of the PCMH.
Literature
1.
Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA. 2009;301(19):2038–40.CrossRefPubMed
2.
3.
Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001.
4.
Pearson SD, Schneider EC, Kleinman KP, Coltin KL, Singer JA. The impact of pay-for-performance on health care quality in Massachusetts, 2001–2003. Health Aff. 2008;27:1167–76.CrossRef
5.
6.
Roland M. Linking physicians' pay to the quality of care—a major experiment in the United Kingdom. N Engl J Med. 2004;351:1448–54.CrossRefPubMed
7.
Malouin RA, Starfield B, Sepulveda MJ. Evaluating the tools used to assess the medical home. Manag Care. 2009;18(6):44–8.PubMed
8.
Scholle SH, Roski J, Dunn DL, et al. Availability of data for measuring physician quality performance. Am J Manag Care. 2009;15:67–72.PubMed
9.
10.
Selby JV, Uratsu CS, Fireman B, Schmittdiel JA, Peng T, Rodondi N, Karter AJ, Kerr EA. Treatment intensification and risk factor control: toward more clinically relevant quality measures. Med Care. 2009;47(4):395–402.CrossRefPubMed
11.
Thom DH, Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997;44:169–76.PubMed
12.
Thom DH, Bloch DA, Segal ES. An intervention to increase patients’ trust in their physicians. Stanford Trust Study Physician Group. Acad Med. 1999;74:195–8.CrossRefPubMed
13.
Thom DH, Hall MA, Pawlson LG. Measuring patient’s trust in physicians when assessing quality of care. Health Aff (Millwood). 2004;23:124–32.CrossRef
14.
Safran DG, Kosinski M, Tarlov AR, et al. The primary care assessment survey: tests of data quality and measurement performance. Med Care. 1998;36:728–39.CrossRefPubMed
15.
Safran DG, Karp M, Coltin K, et al. Measuring Patients’ Experiences with Individual Primary Care Physicians. Results of a Statewide Demonstration Project. J Gen Intern Med. 2006;21:13–21.CrossRefPubMed
16.
Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005;43:436–44.CrossRefPubMed
17.
18.
19.
Säilä T, Mattila E, Kaila M, Aalto P, Kaunonen M. Measuring patient assessments of the quality of outpatient care: a systematic review. J Eval Clin Pract. 2008;14:148–54.PubMed
20.
Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA. 2003;289(8):1035–41.CrossRefPubMed
21.
Murray M, Bodenheimer T, Rittenhouse D, Grumbach K. Improving timely access to primary care: case studies of the advanced access model. JAMA. 2003;289:1042–6.CrossRefPubMed
22.
Vogt TM, Aickin M, Ahmed F, Schmidt M. The Prevention Index: using technology to improve quality assessment. Health Serv Res. 2004;39:511–30.CrossRefPubMed
23.
Hussey PS, de Vries H, Romley J, et al. A systematic review of health care efficiency measures. Health Serv Res. 2009;44:784–805.CrossRefPubMed
24.
Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.CrossRefPubMed
25.
Gandhi TK, Weingart SN, Seger AC, et al. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med. 2005;20:837–41.CrossRefPubMed
26.
Kohn LT, Corrigan JM, Donaldson MS (eds). Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington DC: National Academy Press: 2000.
27.
Dovey SM, Meyers DS, Phillips RL Jr, et al. A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care. 2002;11:233–8.CrossRefPubMed
28.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: The National Academies Press: 2002.
29.
Hofer TP, Hayward RA, Greenfield S, Wagner EH, Kaplan SH, Manning WG. The unreliability of individual physician report cards for assessing the costs and quality of care of a chronic disease. JAMA. 1999;281:2098–105.CrossRefPubMed
30.
Landon BE, Normand SL. Performance measurement in the small office practice: challenges and potential solutions. Ann Intern Med. 2008;148:353–7.PubMed
31.
32.
Goodman DC, Mick SS, Bott D, et al. Primary care service areas: a new tool for the evaluation of primary care services. Health Serv Res. 2003;38:287–309.CrossRefPubMed
33.
Shi L, Macinko J, Starfield B, Wulu J, Regan J, Politzer R. The relationship between primary care, income inequality, and mortality in US States, 1980-1995. J Am Board Fam Pract. 2003;16:412–22.CrossRefPubMed
34.
Shi L, Macinko J, Starfield B, Politzer R, Wulu J, Xu J. Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990. Am J Public Health. 2005;95:674–80.CrossRefPubMed
35.
Shi L, Macinko J, Starfield B, Xu J, Politzer R. Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985–1995. Stroke. 2003;34:1958–64.CrossRefPubMed
36.
Shi L, Macinko J, Starfield B, et al. Primary care, infant mortality, and low birth weight in the states of the USA. J Epidemiol Community Health. 2004;58:374–80.CrossRefPubMed
37.
Mark DH, Gottlieb MS, Zellner BB, Chetty VK, Midtling JE. Medicare costs in urban areas and the supply of primary care physicians. J Fam Pract. 1996;43:33–9.PubMed
38.
Shi L, Starfield B, Politzer R, Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002;37:529–50.CrossRefPubMed
39.
Shi L, Starfield B. The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas. Am J Public Health. 2001;91:1246–50.CrossRefPubMed
40.
Basu J, Clancy C. Racial disparity, primary care, and specialty referral. Health Serv Res. 2001;36:64–77.PubMed
41.
Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Millwood). 2009;28:323–33.CrossRef
42.
Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27:1235–45.CrossRef
43.
Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable care—two essential elements of delivery-system reform. N Engl J Med. 2009;361(24):2301–2303.CrossRefPubMed
44.
Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293:1239–44.CrossRefPubMed
45.
Werner RM, Konetzka RT, Kruse GB. Impact of public reporting on unreported quality of care. Health Serv Res. 2009;44:379–98.CrossRefPubMed
46.
McDonald R, Roland M. Pay for performance in primary care in England and California: comparison of unintended consequences. Ann Fam Med. 2009;7:121–7.CrossRefPubMed
47.
Nutting PA, Miller WL, Crabtree BF, Jaen CR, Stewart EE, Stange KC. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009;7:254–60.CrossRefPubMed
48.
Werner RM, Asch DA, Polsky D. Racial profiling: the unintended consequences of coronary artery bypass graft report cards. Circulation. 2005;111:1257–63.CrossRefPubMed
49.
Pawlson LG. The past as prologue: future directions in clinical performance measurement in ambulatory care. Am J Manag Care. 2007;13:594–6.PubMed
50.
51.
Metadata
Title
Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home: A Focus on Outcomes
Authors
Diane R. Rittenhouse, MD, MPH
David H. Thom, MD, PhD, MPH
Julie A. Schmittdiel, PhD
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 6/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1289-x

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