title: The patient-centered medical home, electronic health records, and quality of care.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) model of primary care is being implemented widely, although its effects on quality are unclear. The PCMH typically involves electronic health records (EHRs), organizational practice change, and payment reform.
  
  
  OBJECTIVE
  To compare quality of care provided by physicians in PCMHs with that provided by physicians using paper medical records and, separately, with that provided by physicians using EHRs without the PCMH (to determine whether effects were driven by EHRs).
  
  
  METHODS
  Prospective cohort study (2008 to 2010). (ClinicalTrials.gov: NCT00793065).
  
  
  METHODS
  The Hudson Valley, a 7-county, multipayer, multiprovider region in New York.
  
  
  METHODS
  675 primary care physicians in 312 practices and 143,489 patients.
  
  
  METHODS
  Claims for 10 quality measures from the Healthcare Effectiveness Data and Information Set were used. Differences in quality were determined using generalized estimating equations adjusted for 8 physician characteristics and 4 patient characteristics.
  
  
  RESULTS
  The PCMH group improved significantly more over time than either the paper group or the EHR group for 4 of the 10 measures (by 1 to 9 percentage points per measure): eye examinations and hemoglobin A1c testing for patients with diabetes, chlamydia screening, and colorectal cancer screening (adjusted P < 0.05 for each). The odds of overall quality improvement in the PCMH group were 7% higher than in the paper group and 6% higher than in the EHR group (adjusted P < 0.01 for each).
  
  
  CONCLUSIONS
  This study was observational, and the possibility of unmeasured confounders cannot be excluded.
  
  
  CONCLUSIONS
  The PCMH was associated with modest quality improvement. The aspects of the PCMH that drive improvement are distinct from but may be enabled by the EHR.
  
  
  BACKGROUND
  The Commonwealth Fund and the New York State Department of Health.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.forename: Alison
authors.initials: A
authors.lastname: Edwards
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000328:Adult; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York; D018802:Patient-Centered Care / Q000458:organization & administration*; D058007:Physicians, Primary Care; D011320:Primary Health Care; D011787:Quality of Health Care