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Cited by 195Primary Care and Health OutcomesPatient Satisfaction in HealthcareHealthcare Systems and Technology

Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project

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Jaen, C. R., Ferrer, R. L., Miller, W. L., Palmer, R. F., Wood, R., Davila, M., Stewart, E. E., Crabtree, B. F. +2 more·2010·The Annals of Family Medicine
DOI 10.1370/afm.1121PMC PMC2885729
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Abstract

PURPOSE: The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices' transition to patient-centered medical homes (PCMHs). METHODS: In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of how many of 39 predominantly technological NDP model components the practices adopted. We evaluated 2 types of patient outcomes with repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months: patient-rated outcomes and condition-specific quality of care outcomes. Patient-rated outcomes included core primary care attributes, patient empowerment, general health status, and satisfaction with the service relationship. Condition-specific outcomes were measures of the quality of care from the Ambulatory Care Quality Alliance (ACQA) Starter Set and measures of delivery of clinical preventive services and chronic disease care. RESULTS: Practices adopted substantial numbers of NDP components over 26 months. Facilitated practices adopted more new components on average than self-directed practices (10.7 components vs 7.7 components, P=.005). ACQA scores improved over time in both groups (by 8.3% in the facilitated group and by 9.1% in the self-directed group, P <.0001) as did chronic care scores (by 5.2% in the facilitated group and by 5.0% in the self-directed group, P=.002), with no significant differences between groups. There were no improvements in patient-rated outcomes. Adoption of PCMH components was associated with improved access (standardized beta [Sbeta]=0.32, P = .04) and better prevention scores (Sbeta=0.42, P=.001), ACQA scores (Sbeta=0.45, P = .007), and chronic care scores (Sbeta=0.25, P =.08). CONCLUSIONS: After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience. PCMH models that call for practice change without altering the broader delivery system may not achieve their intended results, at least in the short term.

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  • In a study of 36 family practices implementing PCMH components over 26 months, improvement was seen in prevention and chronic care quality metrics, but not in patient-assessed outcomes.

    “In another study of 36 family practices implementing PCMH components over 26 months, improvement was seen in prevention and chronic care quality metrics, but not in patient-assessed outcomes (96).”

    From The CardioMetabolic Health Alliance (2015) · cites this paper as [96]

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Research works printed but not linked: 3

  1. Boult C, Reider L, Frey K, et al. Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-random- ized controlled trial. J Gerontol A Biol Sci Med Sci. 2008;63(3):321-327.
  2. Flocke S. Primary care instrument [letter to editor]. J Fam Pract. 1998;46:12.
  3. U.S. Preventive Services Task Force. The Guide to Clinical Preventive Services 2006: Recommendations From the U.S. Preventive Services Task Force. Washington, DC: Lippincott Williams & Wilkins; 2006.

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Authors
Jaen, C. R., Ferrer, R. L., Miller, W. L., Palmer, R. F., Wood, R., Davila, M., Stewart, E. E., Crabtree, B. F., Nutting, P. A., & Stange, K. C.
ORCID
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2010-05-01
Volume
8
Issue
Suppl_1
Pages
S57-S67
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.1121
PMC
PMC2885729
OpenAlex
W2130208433
Cited by
194
References
45
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 5 · 2018: 8 · 2017: 10 · 2016: 18 · 2015: 23 · 2014: 30 · 2013: 24 · 2012: 23
FWCI
46.63
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Cancer Society
  • Commonwealth Fund
  • American Academy of Family Physicians Foundation
  • American Board of Family Medicine Foundation
  • National Cancer Institute (K05CA140237)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
patient-centered medical home, general practice, quality of care, patient satisfaction, patient empowerment, chronic care, clinical preventive services, implementation facilitation, health care access
MeSH terms
Family Practice, Female, Humans, Male, Middle Aged, Organizational Innovation, Outcome and Process Assessment, Health Care, United States, Randomized Controlled Trials as Topic, Patient Satisfaction, Models, Organizational, Patient-Centered Care, Evidence-Based Practice

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