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The Patient-Centered Medical Home, Electronic Health Records, and Quality of CarePatient-Centered Medical Home and Quality of Care

Lisa M. Kern, MD, MPH; Alison Edwards, MStat; and Rainu Kaushal, MD, MPH
[+] Article, Author, and Disclosure Information

From Weill Cornell Medical College, New York, New York.

An earlier version of this work was presented at the 36th Annual Meeting of the Society of General Internal Medicine, Denver, Colorado, 24–27 April 2013.

Note: Authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis.

Acknowledgment: The authors thank Susan Stuard, MBA, executive director of THINC; A. John Blair III, MD, president of the Taconic IPA and chief executive officer of MedAllies; and Rina Dhopeshwarkar, MPH.

Financial Support: By The Commonwealth Fund (grant 20080473) and the New York State Department of Health (contract C023699).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1798.

Reproducible Research Statement: Study protocol: Selected portions are available to approved persons upon request to Dr. Kern (e-mail, lmk2003@med.cornell.edu). Statistical code and data set: Not available.

Requests for Single Reprints: Lisa M. Kern, MD, MPH, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065; e-mail, lmk2003@med.cornell.edu.

Current Author Addresses: Drs. Kern and Kaushal and Ms. Edwards: Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065.

Author Contributions: Conception and design: L.M. Kern, A. Edwards, R. Kaushal.

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, R. Kaushal.

Final approval of the article: L.M. Kern, A. Edwards, R. Kaushal.

Statistical expertise: A. Edwards.

Obtaining of funding: L.M. Kern, R. Kaushal.

Administrative, technical, or logistic support: L.M. Kern.

Collection and assembly of data: L.M. Kern, A. Edwards.

Ann Intern Med. 2014;160(11):741-749. doi:10.7326/M13-1798
Text Size: A A A

Background: The patient-centered medical home (PCMH) model of primary care is being implemented widely, although its effects on quality are unclear. The PCMH typically involves electronic health records (EHRs), organizational practice change, and payment reform.

Objective: To compare quality of care provided by physicians in PCMHs with that provided by physicians using paper medical records and, separately, with that provided by physicians using EHRs without the PCMH (to determine whether effects were driven by EHRs).

Design: Prospective cohort study (2008 to 2010). (ClinicalTrials.gov: NCT00793065).

Setting: The Hudson Valley, a 7-county, multipayer, multiprovider region in New York.

Participants: 675 primary care physicians in 312 practices and 143 489 patients.

Measurements: Claims for 10 quality measures from the Healthcare Effectiveness Data and Information Set were used. Differences in quality were determined using generalized estimating equations adjusted for 8 physician characteristics and 4 patient characteristics.

Results: The PCMH group improved significantly more over time than either the paper group or the EHR group for 4 of the 10 measures (by 1 to 9 percentage points per measure): eye examinations and hemoglobin A1c testing for patients with diabetes, chlamydia screening, and colorectal cancer screening (adjusted P < 0.05 for each). The odds of overall quality improvement in the PCMH group were 7% higher than in the paper group and 6% higher than in the EHR group (adjusted P < 0.01 for each).

Limitation: This study was observational, and the possibility of unmeasured confounders cannot be excluded.

Conclusion: The PCMH was associated with modest quality improvement. The aspects of the PCMH that drive improvement are distinct from but may be enabled by the EHR.

Primary Funding Source: The Commonwealth Fund and the New York State Department of Health.


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Appendix Figure.

Logic for attributing patients to providers.

E&M = evaluation and management.

* See the Figure for the derivation of the study sample.

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Study flow diagram.

EHR = electronic health record; IPA = Independent Practice Association; PCMH = patient-centered medical home.

* Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

† MDs or DOs in general internal medicine, pediatrics, and family medicine.

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