Patient-Centered Medical Homes

An enhanced way to deliver primary care that provides ongoing, team-based, and coordinated care.  PCMHs are now being tested for their ability to improve outcomes and limit costs growth. 

Factors Associated With Perceived Worsened Physical Health Among Older Adults Who Are Newly Enrolled Long-term Services and Supports Recipients

Jan. 2, 2020

Jasmine L. TraversKaren B. Hirschman, Alexandra L. Hanlon, Liming Huang, Mary D. Naylor

Abstract [from journal]

Limited information exists on the perceived health of older adults new to receiving long-term services and supports (LTSS) compared with the year prior, posing challenges to the anticipation of health care need and optimization of wellness efforts for this growing population. In response, we sought to identify differences in perceived worsened physical health across three LTSS types (nursing home, assisted living, and home and community-based services) along with health-related quality of life (HRQoL) characteristics associated with older adults'


Factors Affecting Patient Prioritization Decisions at Admission to Home Healthcare: A Predictive Study to Develop a Risk Screening Tool

Nov. 21, 2019

Maxim Topaz, Mary Naylor, John Holmes, Kathryn Bowles

Abstract [from journal]

There is a lack of evidence on how to identify high-risk patients admitted to home healthcare. This study aimed (1) to identify which disease characteristics, medications, patient needs, social support characteristics, and other factors are associated with patient priority for the first home health nursing visit; and (2) to construct and validate a predictive model of patient priority for the first home health nursing visit. This was a predictive study of home health visit priority decisions made by 20 nurses for 519 older adults. The study found that


Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Inside the Black Box of Patient-Centered Medical Homes

Aug. 2, 2018

The concept of a patient-centered medical home (PCMH) holds intuitive appeal, with its emphasis on coordination of care, improved patient-provider communication and patient engagement, use of health information technology, and expanded practice hours.

Organizational Processes and Patient Experiences in the Patient-Centered Medical Home

May. 10, 2018

Abstract [from journal]

Background: There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences.

Objective: Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care.

Research Design: We analyzed visit data from patients (n=8356) at adult primary care practices...

System Redesign and the Health Care Workforce

Oct. 19, 2017

An interdisciplinary panel of experts from health care management, economics, and nursing came together at LDI’s 50th Anniversary Symposium to discuss their perspectives on how “organizational innovation” can be used to redesign health care systems and care delivery.

Linda Aiken, PhD, RN, University of Pennsylvania

Continuity of Care in Infancy and Early Childhood Health Outcomes

Jul. 14, 2017

Elizabeth Enlow, Molly Passarella, Scott A. Lorch

In Pediatrics, Elizabeth Enlow and colleagues, including Scott Lorch, assess the relationship between provider continuity in infancy, and use of both urgent and preventative health services. Continuity of care is a key aspect of the patient-centered medical home and has been shown to improve pediatric outcomes. The authors hypothesize that increased provider continuity in infancy decreases urgent health care use and increases preventative services use in early childhood. They measured continuity across all primary care encounters during the first year of life for 17,773 infants...

Association between aggressive care and bereaved families’ evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities

Jul. 11, 2017

Mary Ersek, Susan C. Miller, Todd H. Wagner, Joshua M. Thorpe, Dawn Smith, Cari R. Levy, Risha Gidwani, Katherine Faircy-Anderson, Karl A. Lorenz, Bruce Kinosian, Vincent Mor

In Cancer, Mary Ersek and colleagues, including Bruce Kinosian, assess the relationship between aggressive end-of-life care and patient and family satisfaction. The authors focused on patients requiring an episode of aggressive care (such as chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life among patients with non-small cell lung cancer who died in a Veterans Affairs facility. They used data including Veterans Affairs administrative and clinical data, Medicare claims, and the Bereaved Family Survey....

The “value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations

Jun. 20, 2017

David E. Cohn, Emily Ko, Larissa A. Meyer, Jason D. Wright, Sarah M. Temkin, Jonathan Foote, Nathaniel L. Jones, Laura J. Havrilesky

In Gynecologic Oncology, David Cohn and colleagues, including Emily Ko, examine trends in gynecologic oncology health care expenditures, and assess how costs may be affected by new models of health care delivery and payment. The authors conduct a review on behalf of the Society of Gynecologic Oncology, and discuss the financial burden of increasing co-payments for cancer patients. They emphasize the need for gynecologic oncology practitioners to prepare for new models of cancer care delivery, such as Oncology Patient-Centered Medical Homes (OCPHM), as well as newer pay for...

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

Pennsylvania’s Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medical and Psychiatric Comorbidities

Jun. 27, 2016

Karin V. Rhodes, Simon Basseyn, Robert Gallop, Elizabeth Noll, Aileen Rothbard, and Paul Crits-Christoph

The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008–2011. At its height, it included 783 providers and served more than 1.18 million patients. Evaluation of the program, in terms of quality, utilization, and cost outcomes has been mixed. This study assessed whether the CCI had an impact on the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. The investigators analyzed Medicaid claims to compare changes in utilization and...