PMH Summary of Evidence
To assess how aligning with the PMH vision affects the provision of care in family practices, a comprehensive literature review was performed using various databases. Results indicate that alignment with PMH principles enhances patient access to care, increases patient and provider satisfaction, without increasing health care costs.
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.
Adams S, Beatty M, Moore C, et al. Perspectives on team communication challenges in caring for children with medical complexity. BMC Health Serv Res. 2021;21(1):300. Published 2021 Apr 1. doi:10.1186/s12913-021-06304-8.
Summary of Findings:
The objectives of this study were to explore communication challenges and solutions/recommendations from multiple perspectives including (i) parents, (ii) HCPs - hospital and community providers, and (iii) teachers of children with medical complexity (CMC) with a goal of informing patient care.
Fortin M, Stewart M, Ngangue P, et al. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med. 2021;19(2):126-134. doi:10.1370/afm.2650
Summary of Findings:
This study measured the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
Strasser R, Berry S. Integrated clinical learning: team teaching and team learning in primary care [published online ahead of print, 2021 Feb 16]. Educ Prim Care. 2021;1-5. doi:10.1080/14739879.2021.1882886.
Summary of Findings:
This study focuses on Integrated Clinical Learning (ICL), which is developed in Northern Ontario, Canada and involves a team of clinical teachers from a range of health professions teaching a team of students and trainees together in common community and clinical settings. It is the balanced integration of educational strategies to develop healthcare providers and team-based competencies focused on improving the quality of care. The study shows that the patient and family centred nature of ICL helps bridge the primary care-secondary care divide as students follow their patients into and out of hospital services. This is positive for patients and specialists and provides authentic learning for students. ICL enhances the quality of care; the quality of learning; and the quality of professional satisfaction for primary care clinical teachers.
Donnelly C, Ashcroft R, Bobbette N, et al. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Fam Pract. 2021;22(1):31. Published 2021 Feb 3. doi:10.1186/s12875-020-01366-9.
Summary of Findings:
The objective of the study was to describe the state of interprofessional health provider practice within Interprofessional Care (IPC) teams during the COVID-19 pandemic. Results indicated that wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain.
John JR, Tannous WK, Jones A. Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia [published online ahead of print, 2021 Feb 2]. Prim Care Diabetes. 2021;S1751-9918(21)00007-3. doi:10.1016/j.pcd.2021.01.007.
Summary of Findings:
John JR, Tannous WK, Jones A. Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia [published online ahead of print, 2021 Feb 2]. Prim Care Diabetes. 2021;S1751-9918(21)00007-3. doi:10.1016/j.pcd.2021.01.007. Available from https://pubmed.ncbi.nlm.nih.gov/33547009/
Saynisch PA, David G, Ukert B, Agiro A, Scholle SH, Oberlander T. Model Homes: Evaluating Approaches to Patient-centered Medical Home Implementation. Med Care. 2021;59(3):206-212. doi:10.1097/MLR.0000000000001497.
Summary of Findings:
The study focuses on identifying the impact of different approaches to patient-centered medical home (PCMH) adoption on health care utilization in a long-term, geographically diverse sample of patients. PCMH adoption was associated with a >8% reduction in total expenditures. The study finds significant reductions in emergency department utilization and outpatient care, and both lab and imaging services. Overall, the PCMH model has significant impact on patterns of health care utilization, especially when heterogeneity in implementation is accounted for in program evaluation.
Newbery S, Malette J. Integration of care in Northern Ontario: Rural health hubs and the patient medical home concept. Can J Rural Med. 2021;26(1):7-13. doi:10.4103/CJRM.CJRM_103_19.
Summary of Findings:
With the recent emergence of Ontario Health Teams and the conclusion of the Rural Health Hub (RHH) pilot project, this paper looks into the philosophy, culture and expectations of rural and remote centres with regard to primary care delivery. In conclusion continuity of care, local integration and healthcare culture reform were cited by participants as the most important aspects of optimisation of primary care in their environments.
Cunningham C, Patil T, Shahid R, Patel AB, Oddie S. Patient-Physician Relational Continuity and Health System Utilization among Patients in Alberta. Healthc Q. 2020;22(4):13-21. doi:10.12927/hcq.2020.26089
Summary of Findings: This study examines the association between relational continuity (continuity of care) and healthcare utilization patterns in patients with chronic diseases who do not have a family physician.
John JR, Tannous WK, Jones A. Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients [published online ahead of print, 2020 Apr 1]. Hypertens Res. 2020;10.1038/s41440-020-0431-3. doi:10.1038/s41440-020-0431-3
Summary of Findings: This study evaluates the effectiveness of a patient-centered medical home model called 'WellNet' versus that of standard care on blood pressure (BP) outcomes among hypertensive patients.
Fortuna RJ, Johnson W, Clark JS, Messing S, Flynn S, Judge SR. Impact of Patient-Centered Medical Home Transformation on Providers, Staff, and Quality [published online ahead of print, 2020 Mar 25]. Popul Health Manag. 2020;10.1089/pop.2020.0007. doi:10.1089/pop.2020.0007
Summary of Findings: This study examined the impact of the PCMH model on (1) provider and staff satisfaction, (2) work-life balance, (3) teamwork, (4) professional experience, (5) patient care factors, and (6) quality outcomes.
Canadian Institute for Health Information. How Canada Compares: Results From the Commonwealth Fund’s 2019 International Health Policy Survey of Primary Care Physicians — Accessible Report. Ottawa, ON: Canadian Institute for Health Information; 2020.
Summary of Findings: "This report presents analyses from the Canadian Institute for Health Information (CIHI) on the results of the Commonwealth Fund (CMWF) International Health Policy Survey of Primary Care Physicians. Comparisons of Canadian primary care physicians’ experiences with those of primary care physicians in 10 other developed countries provide important perspectives on how well primary care works in Canada and where improvements still need to be made from the point of view of primary care physicians. "
Somé NH, Devlin RA, Mehta N, Zaric GS, Sarma S. Team-based primary care practice and physician's services: Evidence from Family Health Teams in Ontario, Canada. Soc Sci Med. 2020;264:113310. doi:10.1016/j.socscimed.2020.113310.
Summary of Findings:
This study looks at the impact of switching from non-Family Health Teams to Family Health Teams (FHT) on the production of capitated comprehensive care services, after-hours services, non-incentivized services, and services provided to non-enrolled patients by family physicians. The study found evidence of improved access to physician's services under team-based primary care, but switching to FHTs has no effect on the production of after-hours services and services provided to non-enrolled patients.
Kiran T, Rodrigues JJ, Aratangy T, Devotta K, Sava N, O'Campo P. Awareness and Use of Community Services among Primary Care Physicians. Healthc Policy. 2020;16(1):58-77. doi:10.12927/hcpol.2020.26290.
Summary of Findings:
This study compared awareness and use of community services between physicians practising in team- and non-team-based practice models. Finds suggested that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources.
Cook LL, Golonka RP, Cook CM, et al.
Summary of Findings:
This study explored the relation between a change in access to a primary care physician and continuity of care. Findings indicated that physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access.
Leslie M, Khayatzadeh-Mahani A, Birdsell J, et al. An implementation history of primary health care transformation: Alberta's primary care networks and the people, time and culture of change. BMC Fam Pract. 2020;21(1):258. Published 2020 Dec 5. doi:10.1186/s12875-020-01330-7.
Summary of Findings:
This paper provides an implementation history of the Primary Care Networks (PCNs) in Alberta, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another's cultures; and how best to support the transformation of a system while delivering care locally.
Ammi M, Diop M, Strumpf E. Explaining primary care physicians' decision to quit patient-centered medical homes: Evidence from Quebec, Canada. Health Serv Res. 2019;54(2):367-378. doi:10.1111/1475-6773.13120
Summary of Findings: This study examines the factors explaining primary care physicians' (PCPs) decision to leave patient-centered medical homes (PCMHs).
Szafran O, Kennett SL, Bell NR, Torti JMI. Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team. BMC Fam Pract. 2019;20(1):44. Published 2019 Mar 13. doi:10.1186/s12875-019-0932-9
Summary of Findings: This study examines the extent to which family physicians collaborate with other health professionals in the care of patients with type 2 diabetes mellitus, comparing those who are part of an interprofessional health care team called a Primary Care Network (PCN) to those who are not part of a PCN.
Batista R, Pottie KC, Dahrouge S, et al. Impact of health care reform on enrolment of immigrants in primary care in Ontario, Canada. Fam Pract. 2019;36(4):445-451. doi:10.1093/fampra/cmy082
Summary of Findings: This study analyses whether Ontario's patient enrolment system as part of health care reforms, aimed at enhancing primary health care services reform changed the extent of immigrants' enrolment in primary care services in Ontario between 2003 and 2012.
Oliver D, Deal K, Howard M, Qian H, Agarwal G, Guenter D. Patient trade-offs between continuity and access in primary care interprofessional teaching clinics in Canada: a cross-sectional survey using discrete choice experiment. BMJ Open. 2019;9(3):e023578. Published 2019 Mar 23. doi:10.1136/bmjopen-2018-023578
Summary of Findings: This study examines trade-offs that patients may consider during appointment bookings for six different clinical scenarios across a number of key access and continuity attributes using a discrete choice experiment (DCE) method.
Pariser P, Pham TN, Brown JB, Stewart M, Charles J. Connecting people with multimorbidity to interprofessional teams using telemedicine. Ann Fam Med. 2019;17(Suppl 1):S57-S62.
Summary of Findings: This study evaluates the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP—Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus—a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada.
Health Quality Council of Alberta. A Case Study Evaluation of Crowfoot Village Family Practice and the Taber Clinic. Calgary, AB: Health Quality Council of Alberta; 2019.
Summary of Findings: This study report dispels the value, cost, and quality of care delivered by two primary care clinics in Alberta, Crowfoot Village Family Practice (CVFP) and the Taber Clinic (TC), which have operated under an alternate funding model for the past 20 years, that is unique to other primary care clinics in Alberta.
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.
Summary of Findings: This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada.The preliminary data highlighted the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proved to be effective, efficient, and well received by both patients and physicians.
Summary of Findings: Recently, pharmacists have joined multidisciplinary healthcare teams within family medicine groups (FMG) in Quebec Province, Canada. This study assessed the impact of their interventions on the pharmacotherapy of patients with complex needs monitored in FMGs.In conclusion, family medicine groups pharmacists can detect and resolve DRPs and can reduce medication regimen complexity and non-adherence to treatment in patients with complex needs monitored in FMGs.
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.
Summary of Findings: In Ontario, Canada, the Primary Care Collaborative Memory Clinic (PCCMC) model of dementia care provides a team-based assessment and management service that has demonstrated increased capacity for dementia care at the primary care level. PCCMCs are established following completion of a multi-faceted memory clinic training programme.This study demonstrated that by establishing community partnerships and leveraging existing community resources, the PCCMC model is generalisable to multiple family practice settings including those without integrated interprofessional staff.
Summary of Findings: This article examines the effectiveness of adoption/utilization of an electronic consultation (eConsult) service by primary care providers (PCPs) using a "delegate model," through which referral clerks manage requests on behalf of PCPs, thereby reducing PCPs' administrative burden. The integration of eConsult capability into existing clinic operations was successful in that it allowed the PCPs to request eConsult using a familiar process, avoiding the challenges associated with adopting a new and unfamiliar technology.
Summary of Findings: The objective of this article was to identify and describe features of relationship-based care that contribute to a successful collaborative model of primary care delivery. Four key themes contributing to relationship-based care in the clinic's operation emerged: an activist provider identity, cultural safety, provider-patient relationships, and provider-provider relationships.
Summary of Findings: This article performed a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088).
Sklar M, Seijo C, Goldman RE, Eaton CB. Beyond checkboxes: A qualitative assessment of physicians' experiences providing care in a patient‐centred medical home. Journal of evaluation in clinical practice. 2019 Apr 17.
This study explored the connection between fidelity/adaptation to the PCMH model with implementation successes and challenges through the experiences of family and internal medicine PCMH physicians.Both FCC and IMC physicians spoke positively about their clinic's adherence to the PCMH model of enhanced access to care, coordinated/integrated care, and improvements in quality and safety through data collection and documentation. However, physicians highlighted inadequate staffing and clinic hours. FCC physicians also discussed the challenge of providing high‐quality care amidst differences in coverage between payers.
Stockdale SE, Rose D, Darling JE, Meredith LS, Helfrich CD, Dresselhaus TR, et al. Communication among team members within the patient-centered medical home and patient satisfaction with providers. Med Care. 2018;56(6):491-496.
Summary of Findings: This study examines the relationship between intrateam communication in a PCMH and patients' satisfaction with assigned PCPs, and whether patient-provider communication mediates this relationship. In conclusion PCMH environments with better communication among team members are likely to experience better patient-provider communication and high patient satisfaction. PCMH practices with low ratings of patient satisfaction may need to look beyond individual PCPs to communication within and across teams.
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.
Summary of Findings: This article compared health outcomes associated with primary care networks versus conventional primary care. Findings suggested that patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years.
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.
Summary of Findings: This paper provided an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario.
Summary of Findings: The objective of this study was to determine whether the Patient-Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH. Hospital utilization was reduced by 13.9 percent for PCMH-targeted conditions and ED utilization by 11.2 percent.
Green LA, Chang HC, Markovitz AR, Paustian ML. The reduction in ED and hospital admissions in medical home practices is specific to primary care–sensitive chronic conditions. Health services research. 2018 Apr;53(2):1163-79.
To determine whether the PCMH transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in our setting. Results indicate that PCMH transformation reduces hospital and ED use, and the majority of the effect is specific to PCMH-targeted conditions. Over a 3‐year period, PCMH score was negatively associated with inpatient admissions and ED visits: as PCMH score increased, inpatient admissions and ED visits decreased
by 3.8% and 3.7%, respectively. Patients with chronic conditions had greater reductions (13.9% for inpatient admissions and 11.2% ED visits).
Mahmud A, Timbie JW, Malsberger R, Setodji CM, Kress A, Hiatt L, Mendel P, Kahn KL. Examining differential performance of 3 medical home recognition programs. The American journal of managed care. 2018 Jul;24(7):334-40.
The authors examined differences in patient outcomes associated with 3 patient-centered medical home (PCMH) recognition programs. After 3‐years, PCMH practices had reduced primary care visits, reduced specialist visits, reduced ED visits, and reduced inpatient admissions in comparison to practices with no PCMH recognition. There was no change in ACSC inpatient admissions.
Marsteller JA, Hsu YJ, Gill C, Kiptanui Z, Fakeye OA, Engineer LD, Perlmutter D, Khanna N, Rattinger GB, Nichols D, Harris I. Maryland multipayor patient-centered medical home program: a 4-year quasiexperimental evaluation of quality, utilization, patient satisfaction, and provider perceptions. Medical care. 2018 Apr;56(4):308.
The study evaluates the impact of the Maryland Multipayor Patient centered Medical Home Program (MMPP), launched in 2011. After 3 years, PCMH patients were
9% less likely to experience an ED visit, 34% more likely to experience an inpatient stay, and were 51% more likely to experience a 30‐day readmission in comparison to non‐PCMH patients. Patients with asthma, CHF or diabetes were 19% less likely to experience an ED visit, and were 32% less likely to experience an inpatient stay.
McAlister FA, Bakal JA, Green L, Bahler B, Lewanczuk R. The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions. CMAJ. 2018 Mar 12;190(10):E276-84.
To examine whether patients of primary care networks had fewer visits to the emergency department and acute care hospital admissions than patients cared for by primary care physicians who are not affiliated with a primary care network (“conventional primary care”).The mean inpatient cost per patient was significantly lower in the primary care
network (PCMH‐like model).
Szafran O, Kennett SL, Bell NR, Green L. Patients’ perceptions of team-based care in family practice: access, benefits and team roles. Journal of Primary Health Care. 2018 Sep 1;10(3):248-57.
The purpose of this study was to examine patients’ perceptions of team-based care in family practice. Of the 44.3% (565/1274) of respondents, 41.8% (231/552) reported receiving care from a team of health professionals, primarily for chronic disease management or pharmacy consultations. Patients perceive that team-based care in family practice has improved their knowledge and access to care, overall health and avoided some emergency department visits and hospital admissions. The findings support the continued development of team-based care in family practice.
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.
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.
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.
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.
Schottenfeld L, Petersen D, Peikes D, Ricciardi R, Burak H, McNellis R, et al. Creating Patient centered Team-based Primary Care. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
Summary of Findings: This paper: (1) proposes a conceptual framework for the integration of team-based care and patient-centered care in primary care settings; and (2) offers some practical strategies to support the implementation of patient-centered team-based primary care.
Richardson JE, Kern LM, Silver M, Jung HY, Kaushal R, HITEC investigators. Physician satisfaction in practices that transformed into patient-centered medical homes: A statewide study in New York. Am J Med Qual. 2016;31(4):331-336.
Summary of Findings: This study surveyed 159 community-based physicians in 159 practice sites that had experienced PCMH practice transformations in New York State, to analyse how Patient-centered medical home (PCMH) transformations affect physicians' job satisfaction.
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.
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.
Kiran T, Kopp A, Moineddin R, Glazier RH. Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention. CMAJ. 2015;187(17):E494-E502
Summary of Findings: This study evaluated a large-scale transition of primary care physicians to blended capitation models and team-based care in Ontario, Canada, to understand the effect of each type of reform on the management and prevention of chronic disease.
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.
Alexander JA, Markovitz AR, Paustian ML, Wise CG, El Reda DK, Green LA, Fetters MD. Implementation of patient-centered medical homes in adult primary care practices. Medical Care Research and Review. 2015 Aug;72(4):438-67.
The study evaluates geographically and sociodemographically diverse nonpediatric Michigan primary care practices that participated in Blue Cross Blue Shield of Michigan’s (BCBSM) Physician Group Incentive Program (PGIP), a voluntary incentive and payment reform program designed to support physician organizations achieving transformation into PCMH.
Cole ES, Campbell C, Diana ML, Webber L, Culbertson R. Patient-centered medical homes in Louisiana had minimal impact on Medicaid population’s use of acute care and costs. Health Affairs. 2015 Jan 1;34(1):87-94.
To determine if a primary care clinic that obtains PCMH certification from the NCQA provide higher quality care for its Medicaid patients (as measured by more appropriate utilization and fewer acute care needs) and reduced total health expenditures compared to a similar clinic that is not certified. 22 out of the 27 participating clinics received funds from the Primary Care Access and Stabilization Grant, a grant program aimed at increasing quality of care for patients of safety‐net clinics in the New Orleans area.
David G, Gunnarsson C, Saynisch PA, Chawla R, Nigam S. Do patient‐centered medical homes reduce emergency department visits?. Health services research. 2015 Apr;50(2):418-39.
Independence Blue Cross (IBC) of Pennsylvania, the largest commercial health plan in the Philadelphia area, implemented the Pennsylvania’s Chronic Care Initiative, a multistakeholders effort aimed at improving the quality of primary care for patients with chronic illness. Medical practices participating in the program received financial and
logistical support from IBC and were required to achieve PCMH designation from the NCQA at Level 1 or higher.
Friedberg MW, Rosenthal MB, Werner RM, Volpp KG, Schneider EC. Effects of a medical home and shared savings intervention on quality and utilization of care. JAMA internal medicine. 2015 Aug 1;175(8):1362-8.
To measure associations between participation in the Northeastern Pennsylvania Chronic Care Initiative and changes in quality and utilization of care. During a 3-year period, this medical home intervention, which included shared savings for participating practices, was associated with relative improvements in quality, increased primary care utilization, and lower use of emergency department, hospital, and specialty care. 3 years post‐certification, PMCH practices had fewer all‐cause ED visits, fewer all‐cause hospitalizations, fewer ACS ED visits, fewer ambulatory visits to specialists, and more ambulatory primary care visits.
Maeng DD, Khan N, Tomcavage J, Graf TR, Davis DE, Steele GD. Reduced acute inpatient care was largest savings component of Geisinger Health System’s patient-centered medical home. Health Affairs. 2015 Apr 1;34(4):636-44.
The study estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of 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.
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.
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.
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.
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.
Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. Jama. 2014 Feb 26;311(8):815-25.
To measure associations between participation in the Southeastern Pennsylvania Chronic Care Initiative, one of the earliest and largest multipayer medical home pilots conducted in the United States, and changes in the quality, utilization, and costs of care. 3 years’ post‐certification, PMCH practices had fewer all‐cause ED visits, fewer all‐cause hospitalizations, fewer ACS ED visits, fewer ambulatory visits to specialists, and more ambulatory primary care visits.
Nelson KM, Helfrich C, Sun H, Hebert PL, Liu CF, Dolan E, Taylor L, Wong E, Maynard C, Hernandez SE, Sanders W. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA internal medicine. 2014 Aug 1;174(8):1350-8.
In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. The extent of PCMH implementation, as measured by the Pi2, was highly associated with important outcomes for both patients and providers. This measure will be used to track the effectiveness of implementing PACT over time and to elucidate the correlates of desired health outcomes.
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.
Fifield J, Forrest DD, Burleson JA, Martin-Peele M, Gillespie W. Quality and efficiency in small practices transitioning to patient centered medical homes: a randomized trial. Journal of general internal medicine. 2013 Jun 1;28(6):778-86.
To investigate changes in quality of care (both process and patient outcomes), and efficiency of care that follow from being provided a supportive PCMH transition package compared to attempting the transition without support. After 18‐months, PCMH practices had lower ED use in comparison to non‐PCMH practices. There was no difference in inpatient admissions between PCMH and non‐PMCH practices.
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.
DeVries A, Li CH, Sridhar G, Hummel JR, Breidbart S, Barron JJ. Impact of medical homes on quality, healthcare utilization, and costs. The American journal of managed care. 2012 Sep;18(9):534-44.
To assess baseline quality metrics, healthcare utilization, and costs of commercially insured patients treated at practices participating in a PCMH pilot. PCMH patients had lower ED and inpatient admissions in comparison to control patients over a 2‐year period. This finding was similar for pediatric and adult age groups (18‐44 years, and 45‐64 years).
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.
Edwards ST, Bitton A, Hong J, Landon BE. Patient-centered medical home initiatives expanded in 2009–13: providers, patients, and payment incentives increased. Health Affairs. 2014 Oct 1;33(10):1823-31.
Group Health (a health care insurance plan and integrated delivery system in western Washington state) implemented a series of clinical, staffing and structural reforms to improve efficiency and access within a single metropolitan Seattle clinic.Core change components focused on 4 domains: clinic or team structure, point of care, patient outreach, and clinic management.
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.