A Patient’s Medical Home will regularly evaluate the effectiveness of its services, as a part of its commitment to continuous quality improvement. Quality not only refers to the effectiveness of a practice’s services, but also to the care that the PMH provides for patients both during and between visits.
Supporting Research Articles
Applequist J, Miller-Day M, Cronholm PF, Gabbay RA, Bowen DS. "In Principle We Have Agreement, But in Practice It Is a Bit More Difficult": Obtaining Organizational Buy-In to Patient-Centered Medical Home Transformation. Qual Health Res. 2017;
Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state. The analysis revealed three overarching themes: (a) communication among staff that is open, consistent; (b) implementation of reinforcement techniques; and (c) access to a change implementer who encourages successful evolution.
Pinto AD, Bloch G. Framework for building primary care capacity to address the social determinants of health. Can Fam Physician. 2017;
This article provides a framework that can assist every large primary care organization in establishing a similar committee dedicated to SDOH, which could help build a network across Canada to share lessons learned and support joint advocacy.
Shippee ND, Finch M, Wholey D. Using Statewide Data on Health Care Quality to Assess the Effect of a Patient-Centered Medical Home Initiative on Quality of Care. Popul Health Manag. 2017;.
Minnesota's Health Care Home (HCH) initiative is a statewide medical home model relying on state-run, adaptive certification and supportive data infrastructure. This longitudinal study leverages a unique statewide system of clinic-reported, patient-level quality data (2010-2013) to assess the effect of being in a HCH clinic on health care quality.
Katz A, Herpai N, Smith G, Aubrey-Bassler K, Breton M, Boivin A, Hogg W, Miedema B, Pang J, Wodchis WP, Wong ST. Alignment of Canadian Primary Care With the Patient Medical Home Model: A QUALICO-PC Study. Ann Fam Med. 2017;
Provincial PMH scores indicate considerable room for improvement if the PMH goals are to be fully implemented in Canada.
Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev. 2017;
Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.
Klein D, Kallio M, Humphries S, Mueen M. Collaborative team-based health promotion in a primary care setting: The MOVE program. Can Fam Physician. 2017
Being involved in innovative primary care-based health promotion activities is a way for FPs to achieve success in changing patients' behaviour.
Rosland AM, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, Nelson K. Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study.
Health Serv Res. 2017;
Veterans Health Administration primary care clinics with the most PCMH components in place in 2012 had greater improvements in several chronic disease quality measures in 2009-2013 than the lowest PCMH clinics.
Yau I, Kendall C. Socioeconomic status and allied health use: Among patients in an academic family health team. Can Fam Physician. 2016:
Within an academic FHT, lower-income patients were more likely to use allied health services, suggesting equitable allocation of resources. We encourage other FHTs to similarly assess their allied health resource allocation as an important outcome for investments in Ontario FHTs.
McHugh M, Shi Y, Ramsay PP, Harvey JB, Casalino LP, Shortell SM, Alexander JA. Patient-Centered Medical Home Adoption: Results from Aligning Forces for Quality. Health Aff (Millwood). 2016;
We found no difference in the overall growth of adoption of the processes between the two types of communities. However, improvement on a care coordination subindex was 7.17 percentage points higher in Aligning Forces for Quality communities than in others.
Slater M, Kiran T. Measuring the patient experience in primary care: Comparing e-mail and waiting room survey delivery in a family health team. Can Fam Physician. 2016;
Practices should consider evaluating for nonresponse bias and adjusting for patient demographic characteristics when interpreting survey results. Further research is needed to understand how primary care practices can optimize electronic survey delivery methods to survey a representative sample of patients.
Wong ES, Rosland AM, Fihn SD, Nelson KM. Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden. J Gen Intern Med. 2016;
Increases in PCP visits attributable to PCMH were greater among patients with higher comorbidity. Health systems implementing PCMH should account for population-level comorbidity burden when planning for PCMH-related changes in PCP utilization.
Hall barber K, Schultz K, Scott A, Pollock E, Kotecha J, Martin D. Teaching Quality Improvement in Graduate Medical Education: An Experiential and Team-Based Approach to the Acquisition of Quality Improvement Competencies. Acad Med. 2015;
This study evaluates a graduate medical education curriculum to engage family physicians in quality improvement initiatives. The curriculum successfully improved resident compentency to apply quality improvement methods to their practice and research roles.
Kaushal R, Edwards A, Kern LM. Association between the patient-centered medical home and healthcare utilization. Am J Manag Care. 2015;21(5):378-86.
This study demonstrates that the Patient's Medical Home model decreases healthcare costs, as patients use less emergency services and there is a reduction in preventable specialist referrals.
Wozniak L, Soprovich A, Rees S, et al. Impact of Organizational Stability on Adoption of Quality-Improvement Interventions for Diabetes in Primary Care Settings. Can J Diabetes. 2015;
Although there have been tremendous advances in diabetes care, including the development of efficacious interventions, there remain considerable challenges in translating these advances into practice. Four Primary Care Networks (PCNs) in Alberta implemented 2 quality-improvement interventions focused on lifestyle and depression as part of Alberta's Caring for Diabetes (ABCD) project.
Ivers, N., Barnsley, J., Upshur, R., Tu, K., Shah, B., Grimshaw, J., et al. (2014). "My approach to this job is…one person at a time": Perceived discordance between population-level quality targets and patient-centred care. Canadian Family Physician, 60, 258.
Summary of Findings: This qualitative study interviews family physicians to determine gaps between quality improvement initiatives and patient centred care. The study recommends a quality improvement framework.
Rutten, L. F., Vieux, S., Sauver, J. S., Arora, N., Moser, R., Beckjord, E., et al. (2014). Patient perceptions of electronic medical records use and ratings of care quality. Journal of Patient Related Outcome Measures, 2014, 17-23.
Summary of Findings: This study examines patient perceptions on how electronic medical records relate to quality of care. Patients with a personal family physician using electronic medical records reported higher qualities of care.
Wald, H., George, P., Reis, S., & Taylor, J. (2014). Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting. Academic Medicine, 89, 380-386.
Summary of Findings: This study discusses the benefits of Electronic Medical Record (EMR) use as part of a physicians undergraduate medical education, exemplified at the Alpert Medical School of Brown University. Graduates of the program are exponetially more confident in intergrating electronic medical records into the patient-physician relationship.
Sukalich, S., Elliott, J., Ruffner, G. (2014). Teaching medical error disclosure to residents using patient-centered simulation training. Journal of Academic Medicine , 89, 136-143.
Summary of Findings: This study evaluates medical error disclosure to patients as a part of medical training as this is an important part of patient-centred care. Residents with training in medical error disclosure show statistically significant improvements in comprehensive care.
Lakbala, P., & Dindarloo, K. (2014). Physicians’ perception and attitude toward electronic medical records. The Journal of Family Medicine, 3, 63.
Summary of Findings: This cross-sectional survey found that physician’s perceptions of Electronic Medical Records are largely positive. Over 85% of physicians surveyed believe EMR’s should be implemented with the help of government and policy makers to provide incentives.
Oswald, A., Czupryn, J., Wiseman, J., & Snell, L. (2014). Patient‐centred education: What do students think? Medical Education, 48(2), 170-180. doi:10.1111/medu.12287
Summary of Findings: In this study, pre-clinical medical students were asked to submit written assignments on patient-centredness. Most students reported seeing illness in the context of patients lives as a primary component of quality care, emphasising the necessity of patient-centredness as a core aspect of a healthcare system.
Cook, D., M.D., Rocker, G., D.M., & Heyland, D., M.D. (2013). Enhancing the quality of end-of-life care in canada. Canadian Medical Association.Journal, 185(16), 1383-4. Retrieved from http://search.proquest.com/docview/1476500531?accountid=14771
Summary of Findings: This study interviews hospitalized Canadians on which aspects of end-of-life treatment they find to be most important. Trust in a personal family physician and effective communication among health care team members were consistantly reported to play a pivitol role in the quality of palliative care.
Green, B. B. (2013). Caring for Patients with Multiple Chronic Conditions: Balancing Evidenced-based and Patient-Centered Care. The Journal of the American Board of Family Medicine , 26, 484-485.
Summary of Findings: This study discusses the need for team-based care due to the increasingly high rates of patients suffering from multiple chronic illnesses. Patients with well controlled chronic illnesses are significantly more likely to have access to a health care team, in addition to their personal family physician.
Cauch-Dudek, K., Victor, J. C., Sigmond, M., & Shah, B. R. (2013). Disparities in attendance at diabetes self-management education programs after diagnosis in ontario, canada: A cohort study. BMC Public Health, 13, 85. doi: http://dx.doi.org/10.1186/1471-2458-13-85
Summary of Findings: This study finds that only 1 in 5 patients newly diagnosed with diabetes attend diabetic publicly funded self-management education programs. Emphasising the need for greater comprehensive care, especially in communities with low rates of health program utilization.
Sibbald, S. L., McPherson, C., & Kothari, A. (2013). Ontario primary care reform and quality improvement activities: An environmental scan. BMC Health Services Research, 13(1), 209. doi: http://dx.doi.org/10.1186/1472-6963-13-209
Summary of Findings: This study evaluates current quality improvement initiatives in Ontario, Canada and recommends an organized framework to ensure Patient’s Medical Home goals are met.
Daniel, D., Wagner, E., Coleman, K., Schaefer, J., Austin, B., & Abrams, M. (2013). Assessing Progress toward Becoming a Patient‐Centered Medical Home: An Assessment Tool for Practice Transformation. Health Services Research, 48, 1879-1897.
Summary of Findings: This study provides a Patients Medical Home implementation guide to monitor clinic progress in transitioning to patient-centred care. It highlights the importance of clinic quality improvement to ensure the best possible patient outcomes.
Hilts, L., Howard, M., Price, D., Risdon, C., Agarwal, G., & Childs, A. (2013). Helping primary care teams emerge through a quality improvement program. Family Practice, 30.
Summary of Findings: This study measured the relationship between healthcare team perceptions on their care roles and patient health outcomes. Healthcare teams with a better understanding of their role tended to see higher positive patient health outcomes.
Mittelstaedt, T., Mori, M., Lambert, W., Saultz, J. (2013). Provider practice characteristics that promote interpersonal continuity. Journal of the American Board of Family Medicine, 26, 356.
Summary of Findings: This mixed method study examined the relationship between provider practice characteristics and interpersonal continuity. It determined patients receive greater continuity of care when they have access to nurses and physicians assistants in addition to their own personal family physician.
Giordano, C., Arenson, C., Lyons, K., Collins, L., Umland, E., Smith, K. (2013). Effect of the health mentors program on student attitudes toward team care. Journal of the American Board of Family Medicine , 42, 120.
Summary of Findings: This study evaluates the effects of a longitudinal study on an education program to train future health professionals skills for efficient team-based care. The program resulted in a significant improvement in attitudes toward team care in addition to a higher quality of care.
Fawole, O., Dy, S., Wilson, R., Lau, B., Martinez, K., Apostol, C., et al. (2013). A Systematic Review of Communication Quality Improvement Interventions for Patients with Advanced and Serious Illness. Journal of General Internal Medicine: JGIM, 28, 570.
Summary of Findings: This study evaluates the impact of various quality improvement methods on physician-patient communication. It finds that patient-centred consultative care is the most effective quality improvement intervention, especially among the chronically ill.
Sung, N., Markuns, J., Park, K., Kim, K., Lee, H., Lee, J. (2013). Higher quality primary care is associated with good self-rated health status. The Journal of Family Practice , 30, 568-575.
Summary of Findings: This study determines that there is a high association between quality of primary care and patient reported health outcomes across a majority of demographics. Patients with the most positive health outcomes reported high levels of personalized, comprehensive, coordinated care from their personal family physician.
Brown, A. E., & Pavlik, V. N. (2013). Patient Centred Research Happens in Practice-Based Research Networks. Journal of the American Board of Family Medicine, 26, 481-483.
Summary of Findings: This article discusses the benefits of conduting medical research in a clinic setting in order to obtain the best patient-centred results. Research suggests that policy makers invest in patient-centred research in these settings for outcomes that can be applied to actual medical practice.
Michael, M., Schaffer, S., Egan, P., Little, B., & Pritchard, P. (2013). Improving Wait Times and Patient Satisfaction in Primary Care. Journal for Healthcare Quality , 35, 50-60.
Summary of Findings: This study compares two frameworks designed to improve patient satisfaction by minimizing wait times. Both were able to reduce wait times by 10 minutes, leaving room for further research and quality improvement to build on these frameworks to increase quality of care.
Aarts, J. W. M., Huppelschoten, A. G., van Empel, I. W. H., Boivin, J., Verhaak, C. M., Kremer, J. A. M., & Nelen, W. L. (2012). How patient-centred care relates to patients’ quality of life and distress: A study in 427 women experiencing infertility. Human Reproduction, 27(2), 488-495. doi:10.1093/humrep/der386
Summary of Findings: This study uses a cross-sectional questionnaire determines patient centredness in family planning and fertility care strongly relates to patient quality of life. Specifically, participants that received quality patient centred care experienced far fewer instances of anxiety and depression than participants who did not receive the same care.
MacCarthy, D., Kallstrom, L., Kadlec, H., & Hollander, M. (2012). Improving primary care in british columbia, canada: Evaluation of a peer-to-peer continuing education program for family physicians. BMC Medical Education, 12, 110. doi: http://dx.doi.org/10.1186/1472-6920-12-110
Summary of Findings: This study determines a Practice Support Program (PSP) in British Columbia, Canada is an effective way to improve physician office efficiency, strategize wait time reduction methods. Additionally, after participating the PSP program, over 82% participants felt more comfortable diagnosing and treating mental health conditions.
Specialized community-based care: an evidence-based analysis. (2012). Ontario health technology assessment series, 12, 1.
Summary of Findings: This study reviews the effects of comprehensive community care on diabetes, heart disease, and chronic obsturctive pulmonary disease. Populations that receive comprehensive community care are significantly less likely to require emergency services and self report greater quality of life than those who do not have these services.
Klemenc-Ketis, Z., Vanden Bussche, P., Rochfort, A., Emaus, C., Eriksson, T., & Kersnik, J. (2012). Teaching quality improvement in family medicine. Education For Primary Care, 23(6), 378-381.
Summary of Findings: This research report discusses the importance of teaching quality improvement measures throughout medical education. System performance, professional development and patient outcomes significantly benefit from consistant quality improvement systems so that policy makers can make informed decisions on the best practices for patient-centred care.
Sternlieb, J. (2012). Teaching the value of continuity of care: a case conference on long-term healing relationships. Family, Systems & Health: The Journal of Collaborative Family Healthcare, 30, 302-307.
Summary of Findings: This study discusses the importance of continuity of care as part of medical training. Physicians that prioritize continuity of care are far more likely to provide a high quality of comprehensive patient centred care. Their patients are also more likely to have better control over chronic illnesses.
Nasser, M., van Weel, C., van Binsbergen, J., & van de Laar, F. (2012). Generalizability of systematic reviews of the effectiveness of health care interventions to primary health care: concepts, methods and future research. The Journal of Family Practice , 29, i94-i103.
Summary of Findings: This study systematically reviewed a variety of primary care guidelines, such as patient-centred care and continuity of care and determined these goals improved quality of care and patient in among a majority of patient demographics. The researchers additionally note the importance of team-based care, especially in communities of lower socio-econimic status.
Uijen, A., Schers, H., Schellevis, F., & van den Bosch, W. (2012). How unique is continuity of care? A review of continuity and related concepts. The Journal of Family Practice , 29, 264-271.
Summary of Findings: This study examines the universality of the realtionship between the patient and their personal family physician, communication between healthcare professionals. Researchers recommend health policy makers prioritize these aspects of the Patient’s Medical Home as it has proven to be instrumental to high quality care.
Walker J, Harris/Decima. Poll: Nine in ten Canadians have a family doctor. 2009. Available at: http://www.harrisdecima.ca/sites/default/files/releases/061909E.pdf. Accessed August 18, 2011.
Summary of Findings: Almost 90% of Canadians have a personal family doctor. Of those Canadians, 88% rate the care they receive as excellent or good.
Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Managed Care. 2009;15(9):e71-e87.
Summary of Findings: This study surveyed clinics practicing a patient-centred medical home system and found that patients achieve better outcomes at a lower cost compared to clinics not using the PCMH model.
Haggerty JL, Pineault R, Beaulieu M-D, et al. Practice Features Associated With Patient-Reported Accessibility, Continuity, and Coordination of Primary Health Care. Ann Fam Med. 2008;6(2):116-123.
Summary of Findings: This study compares the relationship between patient-centred care and the sustainability of the Canadian healthcare system. It emphasizes the increased demand for primary care as the population ages, and recommends a shift to patient-centred care in order to sustain the healthcare system and better health outcomes.
Clatney L, MacDonald H, Shah SM. Mental health care in the primary care setting: family physicians’ perspectives. Can Fam Physician. 2008;54(6):884-889.
Summary of Findings: This survey reveals that primary practicioners are unsatisfied with the quality of mental health care they are able to provide for their patients due to barriers in accessing mental health specialists urging the need for increased team-based care.
Soklaridis S, Oandasan I, Kimpton S. Family health teams: can health professionals learn to work together? Canadian Family Physician. 2007;53(7):1198-1199.
Summary of Findings: This study finds the need for more effective opportunities in academic primary care settings for future primary physicians are able to practice teamwork and collaboration with other health professionals.