Studies offer close-up look at medical home model

The difficulty in precisely measuring the benefits of the patient-centered medical home model comes across in two new studies offering seemingly contradictory insights on the concept.

A three-year study comparing 32 Southeast Pennsylvania practices (including six nurse-managed health centers) that adopted National Committee for Quality Assurance medical home standards with 29 that had not found significant improvement in only one of 11 quality measures—monitoring kidney disease in diabetics—and “no robust associations with utilization and or costs,” according to findings published in JAMA. This study was done by Boston-based researchers with the RAND Corp.

There were 64,243 patients in the medical home practices and 55,959 patients in the comparison group. Researchers used claims data from four health plans and the study ran between June 1, 2008, and May 31, 2011.

But, in the RAND study's third year, these admissions were higher among the medical home-cared for patients than for those in the comparison group—83 per 1,000 patients compared to 72. The researchers noted, however, that few medical home practices increased their night and weekend hours, which is seen as a strategy to prevent these hospitalizations.

Primary-care physicians in practices achieving NCQA medical home status received bonuses of about $92,000 over the course of the study. The percentage of practices using disease registries increased from 30% to 85% and the percentage using electronic prescribing grew from 38% to 86%. But this resulted in “few statistically significant results,” the Rand researchers wrote