title: Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief.
abstract: The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures. The initiatives were associated with a 1.5 percent reduction in the use of specialty visits and a 1.2 percent increase in cervical cancer screening among all patients, and a 4.2 percent reduction in total spending (excluding pharmacy spending) and a 1.4 percent increase in breast cancer screening among higher-morbidity patients. These associations were significant. Identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.
authors.affiliation: Anna D. Sinaiko is a research scientist in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Sinaiko
authors.affiliation: Mary Beth Landrum is a professor of biostatistics in the Department of Health Care Policy at Harvard Medical School, in Boston.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: David J. Meyers is a doctoral student in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island.
authors.forename: David J
authors.initials: DJ
authors.lastname: Meyers
authors.affiliation: Shehnaz Alidina is a research associate in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health.
authors.forename: Shehnaz
authors.initials: S
authors.lastname: Alidina
authors.affiliation: Daniel D. Maeng is a research investigator at the Center for Health Research in the Geisinger Health System, in Danville, Pennsylvania.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Maeng
authors.affiliation: Mark W. Friedberg is a senior natural scientist and director at the RAND Corporation in Boston.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.affiliation: Lisa M. Kern is an associate professor of health care policy and research at Weill Cornell Medical College, in New York City.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.affiliation: Alison M. Edwards is a senior research biostatistician at Weill Cornell Medical College.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Edwards
authors.affiliation: Signe Peterson Flieger is an assistant professor of public health and community medicine at the Tufts University School of Medicine, in Boston.
authors.forename: Signe Peterson
authors.initials: SP
authors.lastname: Flieger
authors.affiliation: Patricia R. Houck is a statistician at UPMC Health Plan, in Pittsburgh, Pennsylvania.
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.affiliation: Pamela Peele is vice president of health economics at UPMC Health Plan.
authors.forename: Pamela
authors.initials: P
authors.lastname: Peele
authors.affiliation: Robert J. Reid is an affiliate investigator, Group Health Research Institute, in Seattle, Washington.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.affiliation: Katharine McGraves-Lloyd is a senior business information analyst at Anthem Inc., in Washington, D.C.
authors.forename: Katharine
authors.initials: K
authors.lastname: McGraves-Lloyd
authors.affiliation: Karl Finison is director of analytic development at Onpoint Health Data, in Portland, Maine.
authors.forename: Karl
authors.initials: K
authors.lastname: Finison
authors.affiliation: Meredith B. Rosenthal (mrosenth@hsph.harvard.edu) is a professor of health economics and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
mesh_terms: D055088:Early Detection of Cancer; D004636:Emergency Service, Hospital; D017048:Health Care Costs; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration
keywords: Cost of Health Care; Primary Care; Quality Of Care