Patient-Centered Medical Home (PCMH) - Assessing the Impact

Study Description and Methods

Through qualitative interviews we will assess the impact of the WellMed PCMH on patient care and health outcomes over the last 10 years (1997-2006). We will evaluate the clinical outcomes, economic expenditures, and patient and provider satisfaction for a medium-sized primary care health system that has implemented a robust, long-term, patient-centered medical home (PCMH).

Specific Aims and Objectives

Our specific aims are:

  1. Determine:
    1. How WellMed developed their level 3 PCMH model—the facilitators, barriers, key components, history, and leadership—using a qualitative methods approach;
    2. How implementation of the WellMed model impacted on patient/provider satisfaction, using a mixed methods approach;
  2. Determine using impact analysis methods if implementation of the WellMed level 3 PCMH improved:
    1. Care for all patients (prevention measures include: cancer screening, immunization, mammography; chronic disease care: aspirin/beta-blocker rates, HTN control, hyperlipidemia control, ACE for DM, ACE for CHF);
    2. Health outcomes for patients with three health conditions (ischemic heart disease [IHD], diabetes mellitus [DM], chronic obstructive pulmonary disease [COPD]). (Health outcome measures include: clinical outcome test values, hospitalization, mortality).
  3. Determine the incremental in-practice expenses per patient per month required to operate the WellMed patient-centered medical home, and each of the key components of the program.

Timeline

This study will be conducted from July 2009 through December 2010.

Status

This project is currently closed. Please see below for key findings and publications.

Contact Information

For additional information about this study, please contact:

David West, PhD
Principal Investigator
Associate Professor
University of Colorado at Denver
1-303-724-1170
david.west@ucdenver.edu

Key Findings and Publications

WellMed Inc (San Antonio, Texas) implemented many patient-centered services, experimenting to find which belong within clinics and which operate best as system functions. The adjusted mortality rate is half that of the state for people older than 65 years. Hospitalization and readmission rates and emergency department visits have not changed over time, but preventive services have improved. Phased implementation across the network makes it difficult to link improvements to specific processes but they seem to have improved outcomes collectively.

Access the complete manuscripts:

Off the Hamster Wheel? Qualitative Evaluation of a Payment-Linked Patient Centered Medical Home (PCMH) Pilot(32 page PDF). Bitton A, Schwartz G, Stewart EE, et al. Milbank Q. Sept 2012; 90(3): 484-515

Case Study of a Primary Care-Based Accountable Care Systems Approach to Medical Home Transformation(11 page PDF). Phillips RL, Bronnikov S, Petterson S, et al. J Ambulatory Care Manage. 2011; 34(1):67-77


This project is funded by a grant from Agency for Healthcare Research and Quality (AHRQ) (HHSA290200710008).