Medical Home Care: Is it Really Better?
Patient-centered medical homes (PCMH) —broadly defined as a way to organize primary care so that individuals get high-quality care across the full range of their health needs—are gaining momentum. The theory behind PCMHs is that when your care is truly coordinated between your primary caregiver and a team of specialists, and there’s a cradle-to-grave focus on preventive care and overall wellness, everybody wins: Costs go down, patients feel (and are) better cared for, staff is happier, and everyone is healthier.
With more and more states encouraging PCMHs through new or revised payment systems, and many industry experts touting them as a major trend to watch, the question is: Does this approach really work?
A recent literature review in the Annals of Internal Medicine addresses the issue. And the findings are largely inconclusive … but can be read as cautiously optimistic. According to the researchers, there is “moderate-strength evidence” that the patient experience is improved in a PCMH setting, at least to a small degree. The same is true for staff experience. But as far as economic gains and clinical outcomes go, the jury is still out. There’s simply not enough evidence in the data to draw a positive conclusion.
Part of the difficulty in assessing the data, the researchers say, is that the definition of a PCMH is inconsistent. In addition, in the studies that have been done so far, very little concerns the general adult and child population of patients: Most of the literature pertains to chronically ill older adults.
As the study concludes: “This review indicated that PCMH is a conceptually sound approach to organizing patient care and appears to hold promise, especially for improving the experiences of patients and staff involved in the healthcare system. Evidence points to the possibility of improved care processes; however, ongoing and future studies are needed.”
No doubt such research is already under way, and, in fact, some pilot programs are already reporting very positive statistics. The likelihood that PCMHs will continue to grow is strong, and architects and designers will be tasked with shaping spaces that best serve this model of care. For an excellent discussion on the topic and its design challenges, see HGA’s blog post “Trends in Collaborative Care.”