Nature And Nurture: What’s Behind the Variation In Recent Medical Home Evaluations?

Recent evaluations of two regional medical home pilots (i.e., efforts to improve the capabilities and performance of primary care practices) within the Pennsylvania Chronic Care Initiative (PACCI) have produced differing results.

In the southeast region of the state, the intervention was associated with improvements in diabetes care, but no changes in other measures of quality, utilization, or costs relative to comparison practices. By contrast, the northeast region’s intervention was associated with favorable changes, relative to comparison practices, in a wider array of quality measures as well as reductions in rates of hospital admissions, emergency department visits, and ambulatory visits to specialists.

Both studies used the same evaluation methods, so it is fair to compare them and instructive to ask: Why do we see these differences? As evaluators and conveners of these regional pilots, we believe both differences in “nature” (i.e., the local contexts into which these interventions were applied) and “nurture” (i.e., the interventions themselves) are responsible.