Primary Care

Study: Medical Home Recognition Significantly Improves Quality of Care

Physician practices participating in medical home interventions, including shared-savings bonus programs, significantly outperformed practices not pursuing medical home recognition, according to a recent study.

The medical home model, which encourages practices to provide well-coordinated patient-centered care, has grown in popularity in recent years, but efforts to measure its impact on actual improvements in quality of care have been inconclusive.
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In order to further explore this issue, researchers from RAND and Harvard University analyzed medical claims for 17,363 patients who attended 27 pilot practices pursuing medical home recognition and 29 comparison practices.

The 27 pilot practices were required to attain recognition from the National Committee for Quality Assurance as “medical homes.” Interventions at these practices included learning collaboratives, disease registries, practice coaching, and shared-savings incentives, in which practices were eligible for bonuses if total spending on patient care was under budget.

Overall, all 27 pilot practices received recognition as medical homes, and after 3 years of follow-up, significantly outperformed comparison practices in the following measures:

  • Diabetes care
  • Breast cancer screening
  • Rates of all-cause hospitalization (8.5 vs 10.2 per 1000 patients per month)
  • Rates of all-cause emergency department visits (29.5 vs 34.2 per 1000 patients per month)
  • Rates of ambulatory care–sensitive emergency department visits (16.2 vs 19.4 per 1000 patients per month)
  • Rates of ambulatory visits to specialists (104.9 vs 122.2 per 1000 patients per month)
  • Rates of ambulatory primary care visits (349.0 vs 271.5 per 1000 patients per month)

“During a 3-year period, this medical home intervention, which included shared savings for participating practices, was associated with relative improvements in quality, increased primary care utilization, and lower use of emergency department, hospital, and specialty care,” they concluded.

“With further experimentation and evaluation, such interventions may continue to become more effective.”

—Michael Potts

Reference:
1. Friedberg MW, Rosenthal MB, Werner RM, et al. Effects of a medical home and shared savings intervention on quality and utilization of care. JAMA Intern Med. 2015 June [epub ahead of print] doi:10.1001/jamainternmed.2015.2047