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. 

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.

Moderator:
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...

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

Sep. 21, 2015

Jaya Aysola, Rachel M. Werner, Shimrit Keddem, Richard SoRelle, and Judy A. Shea

In the Journal of General Internal Medicine, Jaya Aysola and colleagues, including Rachel Werner and Judy Shea, assess patients’ perspectives of the patient-centered medical home (PCMH) model and compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. The authors interviewed 48 patients with diabetes and/or hypertension enrolled in PCMHs within the University of Pennsylvania Health System. They purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether...

Impact of the Patient-Centered Medical Home on Veterans’ Experience of Care

Sep. 14, 2015

Ashok Reddy, Anne Canamucio, Rachel Werner

In the American Journal of Managed Care, Ashok Reddy and colleagues, including Rachel Werner, assess whether the adoption of patient-centered medical homes improves patient experiences of care. Using a linear probability model they tested whether the adoption of the medical home model is associated with changes in patient experiences of care, looking at primary care sites in one region of the Veterans Health Administration. Despite a significant increase in medical home implementation, the authors find no association between medical home adoption and five domains of patient...

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