title: Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation.
abstract: BACKGROUND
  A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management.
  
  
  OBJECTIVE
  To report differences in patient experience, staff burnout, quality, utilization, and costs in the first year of the PCMH demonstration.
  
  
  METHODS
  Prospective before and after evaluation.
  
  
  METHODS
  Baseline (2006) and 12-month (2007) measures were compared. Patient and staff experiences were measured using surveys from a random sample of patients and all staff at the PCMH and 2 control clinics. Automated data were used to measure and compare change components, quality, utilization, and costs for PCMH enrollees versus enrollees at 19 other clinics. Analyses included multivariate regressions for the different outcomes to account for baseline case mix.
  
  
  RESULTS
  After adjusting for baseline, PCMH patients reported higher ratings than controls on 6 of 7 patient experience scales. For staff burnout, 10% of PCMH staff reported high emotional exhaustion at 12 months compared with 30% of controls, despite similar rates at baseline. PCMH patients also had gains in composite quality between 1.2% and 1.6% greater than those of other patients. PCMH patients used more e-mail, phone, and specialist visits, but fewer emergency services. At 12 months, there were no significant differences in overall costs.
  
  
  CONCLUSIONS
  A PCMH redesign can be associated with improvements in patient experience, clinician burnout, and quality without increasing overall cost.
authors.affiliation: Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. reid.rj@ghc.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Onchee
authors.initials: O
authors.lastname: Yu
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Ross
authors.forename: James T
authors.initials: JT
authors.lastname: Tufano
authors.forename: Michael P
authors.initials: MP
authors.lastname: Soman
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018802:Patient-Centered Care / Q000592:standards*; D011446:Prospective Studies; D011594:Psychometrics; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D013997:Time Factors; D014861:Washington