Supporting Research Articles
The PMH model is built on a solid foundation of empirical evidence. The summary of research supporting the model’s effectiveness will be released soon.
Lemire F. Refreshing the Patient’s Medical Home: New vision for providing exceptional care in family practice. Canadian Family Physician. 2019 Feb 1;65(2):152.
Summary of Findings: The article highlights the new Patient's Medical Home Vision by the College of Family Physicians of Canada. It discusses the lessons learned regionally, of opportunities for improvement that continue to be identified, and of anticipated future trends likely to affect the practice of medicine.
Ammi M, Diop M, Strumpf E. Explaining primary care physicians’ decision to quit patient‐centered medical homes: Evidence from Quebec, Canada. Health services research. 2019 Feb 6.
Summary of Findings: This article sheds a light on why approximately 17 percent of primary care physicians (PCPs) leave patient-centered medical homes (PCMHs) within 5 years of follow-up in Quebec. The study highlights that PCMH enables physicians to better support patients with chronic and complex health problems.
Giannitrapani KF, Leung L, Huynh AK, Stockdale SE, Rose D, Needleman J, Yano EM, Meredith L, Rubenstein LV. Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives. Journal of interprofessional care. 2018 Nov 2;32(6):735-44.
Summary of Findings: This qualitative study finds that leadership support and job satisfaction are significantly positively associated with team functioning and produce high functioning PCMH teams.
LaDonna KA, Field E, Watling C, Lingard L, Haddara W, Cristancho SM. Navigating complexity in team‐based clinical settings. Medical Education. 2018 Nov;52(11):1125-37.
Summary Findings: The study explores how clinicians perceive and respond to complex situations and what role does training play in preparing learners to navigate complexities of clinical care. The results indicate that mastering health advocacy is key to navigating complexity and that there should be advocacy training that encourages reflection and engagement in learners.
Tung EL, Gao Y, Peek ME, Nocon RS, Gunter KE, Lee SM, Chin MH. Patient experience of chronic illness care and medical home transformation in safety net clinics. Health services research. 2018 Feb;53(1):469-88.
Summary of Findings: This study finds that a 5-year medical home transformation is associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics.
Wright PM. Reducing health disparities for women through use of the medical home model. Contemp Nurse. 2017;
Summary of Findings: The MHM provides an example of how healthcare can be provided in a more coordinated and effective manner. Extension of this model into the area of women's health may be one way to reduce barriers to quality, accessible care for women.
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.
Flieger SP. Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home. Health Care Manage Rev. 2017;
Team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration.
Pinto AD, Bloch G. Framework for building primary care capacity to address the social determinants of health. Can Fam Physician. 2017;
Summary of Findings: 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.
Gillespie U, Dolovich L, Dahrouge S. Activities performed by pharmacists integrated in family health teams: Results from a web-based survey. Can Pharm J (Ott). 2017;
Pharmacists in FHTs are strongly focused on direct patient care activities, managing specific medication issues and unstructured drug information to physicians.
Ammi M, Ambrose S, Hogg B, Wong S. The influence of registered nurses and nurse practitioners on patient experience with primary care: results from the Canadian QUALICO-PC study. Health Policy. 2017;
Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic.
Allende-Richter SH, Johnson ST, Maloyan M, Glidden P, Rice K, Epee-Bounya A. A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients. Clin Pediatr (Phila). 2017;
Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit.
Franz BA, Murphy JW. The Patient-Centered Medical Home as a Community-based Strategy. Perm J. 2017;
Although many proponents of the PCMH aim to offer patient-centered and sustainable health care, focusing on this philosophical shift will ensure that services are organized by communities in collaboration with health care professionals.
Strumpf E, Ammi M, Diop M, Fiset-Laniel J, Tousignant P. The impact of team-based primary care on health care services utilization and costs: Quebec's family medicine groups. J Health Econ. 2017;
Summary of Findings: Primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms.
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;.
Summary of Findings: 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.
Adaji A, Melin GJ, Campbell RL, Lohse CM, Westphal JJ, Katzelnick DJ. Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients. Popul Health Manag. 2017;
A retrospective health records review was performed for PCMH and non-PCMH patients who presented and received a psychiatric consultation during a 2-year period in the ED of the Mayo Clinic Hospital in Rochester, Minnesota.
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.
Kohler G, Sampalli T, Ryer A, Porter J, Wood L, Bedford L, Higgins-Bowser I, Edwards L, Christian E, Dunn S, Gibson R, Ryan Carson S, Vallis M, Zed J, Tugwell B, Van Zoost C, Canfield C, Rivoire E. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes. Int J Health Policy Manag. 2017;
Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system.
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;
Summary of Findings: 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.
Carter R, Lévesque JF, Harper S, Quesnel‐Vallée A. Measuring the effect of Family Medicine Group (FMG) enrolment on avoidable visits to emergency departments by patients with diabetes in Quebec, Canada. Journal of evaluation in clinical practice. 2017 Apr;23(2):369-76.
Summary of Findings: The study finds that for every 10-percentage point increase in the population enrolled with an FMG in the year prior to an event, there was a 3% reduction in avoidable visits to the ED made by an individual.
Xin H, Kilgore ML, Sen BP. Is access to and use of primary care practices that patients perceive as having essential qualities of a patient-centered medical home associated with positive patient experience? Empirical evidence from a US nationally representative sample. Journal for Healthcare Quality. 2017 Jan 1;39(1):4-14.
Summary of Findings: The study finds that patients within a full medical group home is experience higher odds of patient satisfaction.
Yau I, Kendall C. Socioeconomic status and allied health use: Among patients in an academic family health team. Can Fam Physician. 2016:
Summary of Findings: 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.
Andres C, Spenceley S, Cook LL, Wedel R, Gelber T. Improving primary care: Continuity is about relationships. Can Fam Physician. 2016;
We suggest that the contribution of relational continuity is best captured by measures that give us a sense of how well the primary care provider and team are ensuring that the system wraps around the patient to provide continuous, accessible, person-centred, and comprehensive care. Without these dimensions, any measure of relational continuity is hollow.
Dixon SK, Hoopes AJ, Benkeser D, Grigg A, Grow HM. Characterizing Key Components of a Medical Home Among Rural Adolescents. J Adolesc Health. 2016;
This sample of rural adolescents reported receiving many characteristics of a medical home but had limited experience with personal providers and confidential services. Improving adolescent access to confidential care may be especially important in small, rural communities. The association of a primary provider with improved medical home experience highlights this key characteristic in an adolescent medical home.
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;
Summary of Findings: 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;
Summary of Findings: 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.
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. 2016;
Overall, this study suggests that addressing basic communicative principles among practice team members before, during, and after rollout can increase buy-in when done in an effective manner alongside principles of stakeholder theory. Medical practice members must develop better communicative strategies among providers when undergoing the evolution in order to best benefit from its outcomes.
Cronholm PF, Klusaritz H, Nguyen GT, Kellom K, Kearney M, Miller-Day M, Gabbay R. Resident Engagement in the Patient-Centered Medical Home. Fam Med. 2016;
The presented data describe the complexities of preparing the next generation of providers for practice. Our mixed-methods study illustrated the strengths of participating in the learning collaborative but also areas of focus necessary for improving the experience and educational benefits of PCMH-related curricula involving residents.
Miller D, Baumgartner ET. Lessons from the Community-Centered Health Home Demonstration Project: Patient-Centered Medical Homes Can Improve Health Conditions in Their Surrounding Communities. Prev Chronic Dis. 2016;
All demonstration clinics had an established social mission, and yet the broadening of their focus from individual patient needs to the community’s needs changed their approach to illness and injury prevention.
Yoon J, Chow A, Rubenstein LV. Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs. Med Care. 2016;
Summary of Findings: After PCMH implementation, overall utilization for primary care, specialty care, and mental health/substance abuse care decreased, whereas utilization for telephone care increased among all practices. Patients also had fewer hospitalizations and lower costs per patient.
Carter, R., Riverin, B., Levesque, J., Gariepy, G., & Quesnel-Vallee, A. The impact of primary care reform on health system performance in Canada: A systematic review. BMC Health Services Research, 2016.
Summary of Findings: The summary findings suggest that team-based models of care lead to reductions in emergency department use.
Wozniak L, Soprovich A, Rees S, Al sayah F, Majumdar SR, Johnson JA. Contextualizing the Effectiveness of a Collaborative Care Model for Primary Care Patients with Diabetes and Depression (Teamcare): A Qualitative Assessment Using RE-AIM. Can J Diabetes, 2015.
Summary of Findings: This study evaluates the implementation of collaborative care model for patients suffering from diabetes and depression. The nurse led team care intervention demonstrated statistically significant improvement in depressive symptoms.
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.
Sklar M, Aarons GA, O'connell M, Davidson L, Groessl EJ. Mental Health Recovery in the Patient-Centered Medical Home. Am J Public Health. 2015;105(9):1926-34.
Sommaire des résultats: Cette étude montre qu'il y a une grande augmentation du rétablissement pour la maladie mentale et de la participation active du patient dans son traitement au sein des cliniques qui ont adopté le modèle axé sur le patient du Centre de médecine de famille.
Pineault R, Da silva RB, Provost S, Fournier M, Prud'homme A. [Are new forms of primary health care organization (PHLU) associated with a better health care experience for patients with chronic diseases in Quebec?]. Sante Publique. 2015;27(1 Suppl):S119-28.
Summary of Findings: This study demonstrates through patient survey, that individuals with multiple chronic diseases are more likely to have a positive care experience in clinics that use a Patient Medical Home design.
Bois C, Michaud C, Pineault R, Guay M. [Retombées des ordonnances collectives dans le suivi diabétique conjoint en soins primaires : une étude de cas]. Santé publique. 2015;27(1 Suppl):S111-8.
Sommaire des résultats: Cette étude de cas met l'accent sur les avantages des soins prodigués par une équipe pour les patients diabétiques. Les patients qui reçoivent des soins en équipe bien coordonnés sont plus susceptibles de mieux prendre soin d'eux, ce qui entraînera une meilleure prise en charge de la maladie. (Étude en français)
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, Johnson ST, Majumdar SR, Johnson JA. Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries. Can J Diabetes. 2015;
Summary of Findings: Patient registries are considered and important foundation of chronic disease management, and diabetes patient registries are associated with better processes and outcomes of care. The purpose of this article is to describe the development and use of registries in the Alberta Caring for Diabetes (ABCD) project to identify and reach target populations for quality-improvement interventions in the primary care setting.
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;
Summary of Findings: 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.
Rosenthal, M. B., Sinaiko, A. D., Eastman, D., Chapman, B., & Partridge, G. (2015). Impact of the Rochester Medical Home Initiative on primary care practices, quality, utilization, and costs. Medical care, 53(11), 967-973.
Summary of Findings: The study finds that patients who were part of PCMH practices experienced significant changes in patient care with reductions in ambulatory care, sensitive emergency room visits and use of imaging tests, and increased primary care visits and laboratory tests.
Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V et al. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: A cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technology Assessment 2015;19(13).
Summary of Findings: This study finds that telephone general practitioner and nurse led triage for managing same-day consultation requests in general practice resulted in modest cost savings compared to usual care managed by standard protocol.
Pyne JM, Fortney JC, Mouden S, Lu L, Hudson TJ, Mittal D. Cost-Effectiveness of On-Site Versus Off-Site Collaborative Care for Depression in Rural FQHCs. PS 2015;66(5):491-9
Summary of Findings: This study found that collaborative care using telephone consultation for depression in primary care settings was more effective and cost-effective than in-person consultations.
Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database of Systematic Reviews 2015;(3):CD010523-CD010523.
Summary of Findings: This report finds that personalized care improves some indicators of physical and psychological health status, as well as patients' capability to self-manage their condition compared to usual care.
Oslin, D. W. A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment. Journal of general internal medicine : JGIM, 29, 162. Retrieved June 27, 2014
Summary of Findings: This randomized clinical trial demonstrates patient centred team-based care has the greatest impact on reducing heavy alcohol consumption in patients suffering from alcohol use disorder. Patients also showed significantly greater levels of treatment compliance and engagement in comparison to outpatient programs with less focus on patient-centred care.
Shaw, N. (2014). The role of the professional association: A grounded theory study of electronic medical records usage in Ontario, Canada. International Journal of Information Management, 34(2), 200-209. doi:10.1016/j.ijinfomgt.2013.12.007
Summary of Findings: This grounded theory study examines physician’s experiences with electronic medical record use through interviews and surveys. Physicians reported significant benefits such as ease of use, improvement to comprehensiveness of care and more efficient use of clinical resources.
Wetmore, S. (2014). Patient satisfaction with access and continuity of care in a multidisciplinary academic family medicine clinic. Canadian Family Physician, 60(4), E230.
Summary of Findings: This study assesses patient satisfaction with access and continuity of care in an multidiciplinary family medicine clinic. Patients who were less satisfied with care had longer wait times and less continuity with their personal family physician.
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.
Mautner, D., Pang, H., Brenner, J., Shea, J., Gross, K., Frasso, R. (2013). Generating Hypotheses About Care Needs of High Utilizers: Lessons from Patient Interviews. Population Health Management , 16, S26.
Summary of Findings: This qualitative study interviews patients that are high utilizers of health services to define which characteristics determine excess use. The findings include lack of access to a personal family physician and healthcare team as indicators of overuse of healthcare services.
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.
Muller, S. (2014). Electronic medical records: the way forward for primary care research?. The Journal of Family Practice, 31, 127-129.
Summary of Findings: This article suggests electronic medical records may also be used as a valuable medical research tool with patient consent. Research suggests this information may be a valuable quality improvement tool for patient-centred care.
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.
Kamrul, R., Malin, G., & Ramsden, V. (2014). Beauty of patient-centred care within a cultural context. Canadian Family Physician, 60, 313.
Summary of Findings: This journal article discusses the importance of patient-centred care, primarily in a Canadian culturally diverse context. The researchers encourage a level of cultural competency as a powerful component in comprehensive, patient centred care.
The Conference Board of Canada. Final Report: An External Evaluation of the Family Health Team (FHT) Initiative. Ottawa: The Conference Board of Canada, 2014.
Summary of Findings: The report overall highlights that Family Health Teams have achieved improvements at the organizational and service delivery level, as well showing early signs of improvement in chronic disease management.
Gocan S, Laplante MA, Woodend K. Interprofessional collaboration in Ontario’s family health teams: a review of the literature. Journal of Research in Interprofessional Practice and Education. 2014 Jan 21;3(3).
Summary of Findings: This article finds that Family Health Teams improve healthcare access, greater satisfaction, and enhanced quality of healthcare for both patients and providers.
Paustian ML, Alexander JA, El Reda DK, Wise CG, Green LA, Fetters MD. Partial and incremental PCMH practice transformation: implications for quality and costs. Health services research. 2014 Feb;49(1):52-74.
Summary of Findings: The study examined the associations between partial and incremental implementation of the Patient Centered Medical Home (PCMH) model and measures of cost and quality of care. Results indicated that full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults.
Tricco AC, Antony J, Ivers NM, Ashoor HM, Khan PA, Blondal E et al. Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. Canadian Medical Association Journal 2014;186(15):E568-E578.
Summary of Findings: This study finds that interventions used to improve the coordination of care to reduce health care utilization significantly reduces the number of patients with chronic conditions being admitted to hospitals and reduces emergency visits for older adults.
de Bruin SR, Versnel N, Lemmens LC, Molema CC, Schellevis FG, Nijpels G et al. Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review. Health Policy 2012;107(2-3):108-45.
Summary of Findings: This report provides an insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. It finds that chronic care models that incorporate clinical information systems improve functioning of healthcare practices and health outcomes for patients.
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.
Siminoff, L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC Medical Informatics and Decision Making, 13, S6. doi: http://dx.doi.org/10.1186/1472-6947-13-S3-S6
Summary of Findings: This study evaluates the importance of socio-cultural influences of health and it’s relationship to evidence based medicine. The author stresses the importance of patient-centred care and comprehensive care in order to achieve the best 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.
Henschen, B., Garcia, P., Jacobson, B., Ryan, E., Woods, D., Wayne, D, et al. (2013) The Patient Centered Medical Home as Curricular Model: Perceived Impact of the "Education-Centered Medical Home". Journal of general internal medicine : JGIM, 28, 1105-1109.
Summary of Findings: This study tests the effectiveness of a program called the Education-Centred Medical home, which implements patient-centred care oriented goals into the final years of medical training. Students reported significantly higher levels of confidence in practicing continuity of care and patient centred 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.
Kristjansson, E., Hogg, W., Dahrouge, S., Tuna, M., Mayo-Bruinsma, L., & Gebremichael, G. (2013). Predictors of relational continuity in primary care: Patient, provider and practice factors. BMC Family Practice, 14(1), 72. doi: http://dx.doi.org/10.1186/1471-2296-14-72
Summary of Findings: This cross-sectional study compared a variety of clinics sizes, for example number of physicians practicing, determined that continuity of care is best achieved in clinics with a smaller more cohesive health panel.
Haggerty, J., Roberge, D., Freeman, G., & Beaulieu, C. (2013). Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary. Annals of Family Medicine, 11, 262-271.
Summary of Findings: This qualitative study reviews patient surveys on continuity of care. A majority of patients who experienced continuity of care also had a close relationship with a personal family physician and healthcare team.
Freeman, T., Brown, J., Reid, G., Stewart, M., Thind, A., & Vingilis, E. (2013). Patients’ perceptions on losing access to FPs: qualitative study. Canadian Family Physician, 59, 195-201.
Summary of Findings: This qualitative study interviews individuals on their health-related experiences after losing their personal family physician. A majority of participants reported distress, as they no longer had consistent access to preventative care. The quality of chronic illness management also decreased significantly.
Hudon, C., Tribble, D. S., Bravo, G., Hogg, W., Lambert, M., & Poitras, M., et al. (2013). Family physician enabling attitudes: a qualitative study of patient perceptions. BMC Family Practice, 14.
Summary of Findings: This descriptive qualitative study of patients with at least one chronic illness finds that a positive relationship with their personal family physician was one of the most crucial components to their quality of care. Patients report that physician understanding of their specific illness experience is directly related to health outcomes.
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.
Trivedi D, Goodman C, Gage H, et al. The effectiveness of inter-professional working for older people living in the community: a systematic review. Health & Social Care in the Community. 2013;21(2):113-128.
Summary of Findings: This study finds that models of inter-professional working (IPW )to support older people with complex and multiple needs tend to improve their health, functional, clinical, and process outcomes, including patient and user satisfaction.
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.
Lisa Kern et al., "Electronic Health Records and Ambulatory Quality of Care," Journal of General Internal Medicine, Oct. 3, 2012
Summary of Findings: This study determines that physicians that utilize electronic medical records (EMR) provide significantly higher quality of care compared to practices that are not using EMR’s. Specifically, patients experienced a higher quality of care in diabetes management, clamydia screening and cancer screening.
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.
Alexander, J. A., Hearld, L. R., Mittler, J. N., & Harvey, J. (2012). Patient–Physician Role Relationships and Patient Activation among Individuals with Chronic Illness. Health Services Research, 47, 1201.
Summary of Findings: This cross-sectional study finds that the physician-patient relationship is strongly coorrelated to patient engagement. Patients with strong longitudinal relationships with their personal family physicians are more likely to adhere to treatment plans and experience better health outcomes.
Bryant, S., Lande, G., & Moshavi, D. (2012). A Knowledge-based view of improving the physician-patient relationship. Academy of Health Care Management Journal, 8(1), 9-19. Retrieved from http://search.proquest.com/docview/1037802664?accountid=14771
Summary of Findings: This qualitative study uses hypertension to describe the importance of increased information sharing between patients and physicians. The research stresses physicans to gain a better understanding of patient lifestyles and cultures that may influence comprehensive care.
Randall, E., Crooks, V., Goldsmith, L. (2012). In search of attachment: a qualitative study of chronically ill women transitioning between family physicians in rural Ontario, Canada. BMC Family Practice, 13, 125.
Summary of Findings: This qualitative study interviews women in rural Ontario, Canada with chronic illnesses on continuity of care and stresses the necessity of personal family physicians. There is a shortage in physicians practicing in rural areas, which causes patients to frequently transition through personal family physicians, limiting their continuity of patient-centred care and worsening their health outcomes.
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.
Lawrence, M., & Kinn, S. (2012). Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature. The Journal of Health Expectations, 15, 295-326.
Summary of Findings: This study uses stroke patients as a way to demonstrate the importance of patient-centred interventions. The research finds that patient relevance, communication and quality of care are essential components of patient centred care and must be considered when developing treatment plans.
Fishman PA, Johnson EA, Coleman K, Larson EB, Hsu C, Ross TR et al. Impact on seniors of the patient-centered medical home: Evidence from a pilot study. Gerontologist 2012;52(5):703-11.
Summary of Findings: This study finds that seniors part of a patient-centered medical home (PCMH) had significantly greater quality outcomes over time without significant cost differences as compared to usual care.
Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. American Journal of Psychiatry. 2012 Aug;169(8):790-804.
Summary of Findings: This study finds that models of care that use collaborative team based approach in primary care settings improve quality of life for individuals with chronic medical illnesses and depression.
Hallin K, Henriksson P, Dalén N, Kiessling A. Effects of interprofessional education on patient perceived quality of care. Medical Teacher. 2011 Jan 1;33(1):e22-6.
Summary of Findings: The study assessed patients’ perceptions of collaborative and communicative aspects of care when treated by interprofessional student teams as compared to usual care. In conclusion, patients perceived a higher grade of quality of care when treated and informed by supervised interprofessional student teams.
Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaén CR. Primary care practice development: a relationship centered approach. Ann Fam Med. 2010;8(Suppl 1):S68-S79.
Summary of Findings: Building on existing research on primary care practices, this study further demonstrated the determinants of successful practice development such as comprehensive care and continuity of care. Prioritizing these aspects of the patients medical home dramatically increased chronic disease prevention and treatment.
Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff. 2010;29(7):1370-1375.
Summary of Findings: Implementing secure patient to physican e-mail as part of their EMR system, the clinic saw a statistically significant improvement in the overall health of diabetic patients.
Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF. Principles of the patient-centered medical home and preventive services delivery. Ann Fam Med. 2010;8(2):108-116.
Summary of Findings: This study assessed clinics utilizing the principles of the Patient’s Medical Home, such as a personal family physician, were far more likely to receive preventative services.
Reid RJ, Coleman K, Johnson EA, Fishman PA, Hsu C, Soman MP, Trescott CE, Erikson M, Larson EB. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health affairs. 2010 May 1;29(5):835-43.
Summary of Findings: This study finds that medical homes improve patients’ experiences, quality, and clinician burnout. Their analysis shows that compared to other Group Health clinics, patients in the medical home experienced 29 percent fewer emergency visits and 6 percent fewer hospitalizations.
- Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D. Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine. 2010 Dec 30;363(27):2611-20. Summary of Findings: The study finds that coordinated care and patient-centered management of depression and chronic disease significantly improves control of medical disease and depression.
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.
Atlas SJ, Grant RW, Ferris TG, Chang Y, Barry MJ. Patient–Physician connectedness and quality of primary care. Ann Intern Med. 2009;150(5):325-335.
Summary of Findings: This study demonstrates a strong correlation between a patient’s adherance to treatment and a good relationship with their personal family physician.
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.
Khan S, McIntosh C, Sanmartin C, Watson D, Leeb K. Primary Health Care Teams and Their Impact on Processes and Outcomes of Care. Ottawa, ON: Statistics Canada; 2008. Available at: http://www.statcan.gc.ca/pub/82-622-x/82-622-x2008002-eng.pdf.
Summary of Findings: According to this recent survey, Canadians who have regular access to team based care are significantly less likely to require emergency medical services than those who are not connected to a healthcare team.
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.
Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72(8):1503–1510.
Summary of Findings: Chronic disease patients who participated in this study that had access to a cohesive health care team were able to better self- manage their illness leading to a higher satisfaction with their care.
Murray M, Tantau C. Same-day appointments: exploding the access paradigm. Fam Pract Manage. 2000;7(8):45.
Summary of Findings: Three different primary care appointment booking models are compared. Clinics that have embraced the advanced same-day care model were able to reduce appointment wait times from 55 days to 1 day.