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Results of first national demonstration project to implement patient-centered medical home released
Date:6/15/2010

odel components, and practices in both groups ended up with just over 70 percent of model components in place. "The ability of many self-directed practices to make substantial progress suggests that not all practices need intense assistance," writes Paul A. Nutting, M.D., M.S.P.H., project evaluator and director of research with the Center for Research Strategies in Denver, Colo.

In terms of patient outcomes, adoption of more NDP components was moderately associated with improvement on all three outcomes assessed in medical records audits (an Ambulatory Care Quality Alliance score, a prevention care score and a chronic disease care score) at the 26-month follow-up. Examining condition-specific quality of care, researchers observed absolute improvements in AQA scores of 9.1 percent in the self-directed and 8.3 percent in the facilitated group. Absolute improvements in chronic care scores over 26 months were smaller 5.0 percent in the self-directed group and 5.2 percent in the facilitated group and did not differ between groups. Absolute improvement in prevention scores was not statistically significant.

In contrast, there were no significant improvements in patient-rated outcomes including the four pillars of primary care (access, comprehensive care, coordination, and personal relationship), global practice experience, patient empowerment, or self-rated health status. In fact, there were trends for very small decreases in coordination of care, comprehensive care and access in both groups. Only a handful of the practices transitioned to relatively high levels of use of the NDP model's technical components while also maintaining high ratings of the practices from patients' perspective. Outside facilitation of the change process appeared to buffer some of the negative effects

"Slippage in patient-rated primary care attributes after the NDP began suggests that technical improvements may come at a price, at least in the short term," reports Ca
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Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians
Source:Eurekalert

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