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Medical Home Success Depends on Core Primary Care Attributes
Health IT Overemphasized, Say Researchers
By Sheri Porter
According to the study, however, patient-centered medical home, or PCMH, recognition programs, such as the National Committee for Quality Assurance, or NCQA, tend to emphasize technology over the core principles of primary care, which could create future problems for the medical home model of care. "By not adequately measuring and emphasizing key PCMH principles, particularly the core primary care attributes, these projects risk generating null results which may lead to premature abandonment of the PCMH concept by major payers," the authors concluded.
The research involved 568 patients from 24 primary care practices. Researchers used multiple data sources, including patient surveys, chart audits, practice member questionnaires and medical director surveys.
The primary outcome measured was the rate at which patients were up-to-date on a package of preventive services, including cancer screening, lipid screening, influenza vaccination and behavioral counseling. On average, the rate at which patients were on schedule with receipt of those preventive services was nearly 43 percent.
Study authors found that the frequency with which patients visited a practice made a difference in preventive services received. For example, having 13 or more visits was associated with an average increase in preventive services received of more than 15 percent.
Other factors that significantly increased rates of preventive services included
- seeing the same physician,
- completing a well-patient visit within the past five years and
- having a practice referral system to link patients to community programs.
However, on the health IT front, researchers found a practice's use of clinical decision-support tools to be the only "high-tech" indicator clearly linked to patients receiving preventive services.
Implications for the Medical Home
Furthermore, most pilot projects require that practices receive NCQA medical home recognition as a qualifier for participation, and often, participating practices are strongly encouraged to enhance their health IT capabilities. However, the authors noted that a practice may score well on the NCQA qualification tool but may not necessarily practice patient-centered primary care.
A spokesperson for the NCQA supported the organization's work on creating PCMH standards. Tricia Barrett, vice president of product development, told AAFP News Now that the organization has tried to capture a balance of the application of technology to support patient care and the continuous relationship a patient has with his or her provider.
"Actually, balancing among these standards isn't a tradeoff," said Barrett. "These elements can complement each other." But, she added, "Combining technology with fostering the patient relationship does require adjustment and learning."
Study authors concluded that plenty of evidence was available to show how primary care improves health care services and outcomes, decreases disparities in care, and reduces health care costs. "In contrast, evidence on benefits of health information technology in improving health in community primary care settings has shown mixed results," they said.
Ferrante called for changes in future PCMH projects that would more "adequately measure and emphasize core primary care attributes."