Lisa M. Kern, MD, MPH; Alison Edwards, MStat; Rainu Kaushal, MD, MPH
Acknowledgment: This study was conducted as part of the work of the Health Information Technology Evaluation Collaborative. The authors specifically thank Susan Stuard, MBA, executive director of THINC, and A. John Blair III, MD, president of the Taconic IPA and chief executive officer of MedAllies.
Financial Support: By The Commonwealth Fund (grant 20130685) and the New York State Department of Health (contract C025877).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2633.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Selected portions are available to approved persons from Dr. Kern (e-mail, firstname.lastname@example.org). Statistical code and data set: Not available.
Requests for Single Reprints: Lisa Kern, MD, MPH, Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065; e-mail, email@example.com.
Current Author Addresses: Drs. Kern and Kaushal and Ms. Edwards: Weill Cornell Medical College, 402 East 67th Street, 2nd Floor, New York, NY 10065.
Author Contributions: Conception and design: L.M. Kern, A. Edwards.
Analysis and interpretation of the data: L.M. Kern, A. Edwards, R. Kaushal.
Drafting of the article: L.M. Kern, A. Edwards.
Critical revision of the article for important intellectual content: L.M. Kern, A. Edwards.
Final approval of the article: L.M. Kern, A. Edwards, R. Kaushal.
Statistical expertise: A. Edwards, R. Kaushal.
Obtaining of funding: L.M. Kern.
Administrative, technical, or logistic support: L.M. Kern, R. Kaushal.
Collection and assembly of data: L.M. Kern, A. Edwards.
Effects of the patient-centered medical home (PCMH) are unclear. Previous studies had relatively short follow-up and may not have distinguished effects of the PCMH (which involves electronic health records [EHRs] plus organizational changes) from those of EHRs alone.
To determine effects of the PCMH on health care quality and utilization compared with paper records alone and EHRs alone, with extended follow-up.
Prospective cohort study (2008 to 2012), including 3 years after PCMH implementation. (ClinicalTrials.gov: NCT00793065)
The Hudson Valley, a multipayer, multiprovider region in New York.
438 primary care physicians in 226 practices, with 136 480 patients across 5 health plans.
Level III PCMH, as defined by the National Committee for Quality Assurance.
Claims-based outcomes included 8 quality and 7 utilization measures. Generalized estimating equations were used to compare adjusted differences in rates of change across study groups.
Patterns of quality were fairly similar across groups. Utilization patterns were similar across groups from 2008 to 2011 but showed modest differences between the PCMH and control groups on most measures in 2012. For example, hospitalizations were relatively stable from 2008 to 2011 (approximately 3.9 to 5.2 per 100 patients per year) but decreased in the PCMH group in 2012 (incidence rate ratio, 0.79 [95% CI, 0.69 to 0.90] compared with paper records). Emergency department visits were highest for the PCMH group (16.7 per 100 patients at baseline and 15.4 per 100 patients at the end of the study period) and lowest for the paper group (14.3 per 100 patients at baseline and 12.2 per 100 patients at the end of the study period), but the rate of change did not differ across groups.
Possible unmeasured confounding.
The PCMH was associated with modest changes in most utilization measures and provided similar quality compared with EHRs and paper records.
The Commonwealth Fund and the New York State Department of Health.
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Kern LM, Edwards A, Kaushal R. The Patient-Centered Medical Home and Associations With Health Care Quality and Utilization: A 5-Year Cohort Study. Ann Intern Med. 2016;164:395-405. doi: 10.7326/M14-2633
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Published: Ann Intern Med. 2016;164(6):395-405.
Published at www.annals.org on 16 February 2016
Healthcare Delivery and Policy, High Value Care, Hospital Medicine.
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