A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and S

Authors, Primary Fifield,Judith;Forrest,Deborah Dauser;Martin-Peele,Melanie;Burleson,Joseph A.;Goyzueta,Jeanette;Fujimoto,Marco;Gillespie,William
Title Primary A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices
Periodical Full Journal of General Internal Medicine
Pub Year 2013
Volume 28
issue 6
Start Page 770-7
Abstract BACKGROUND: Transition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices. OBJECTIVE: To test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2-10 providers) primary care practices over 2 years. DESIGN: Randomized Controlled Trial. PARTICIPANTS: Eighteen supported practices (intervention) and 14 control practices (controls). INTERVENTIONS: Intervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance's (NCQA) Physician Practice Connections ─Patient-Centered Medical Home (PPC-PCMH) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC-PCMH. MAIN MEASURES: PPC-PCMH at baseline and 18 months, plus intervention at 7 months. KEY RESULTS: At 18 months, 5 % of intervention practices and 79 % of control practices were not recognized by NCQA; 10 % of intervention practices and 7 % of controls achieved PPC-PCMH Level 1; 5 % of intervention practices and 0 % of controls achieved PPC-PCMH Level 2; and 80 % of intervention practices and 14 % of controls achieved PPC-PCMH Level 3. Intervention practices were 27 times more likely to improve PPC(®)-PCMH™ by one level, irrespective of practice size (p < 0.001) 95 % CI (5-157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect (p (time7) = 0.01), which was twice as large as the sustained effect over subsequent 12 months (p (time18) = 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC-PCMH standards over time (p (time x group) = 0.03). Intervention practices improved eight of nine standards, controls improved three of nine (p (PPC1) = 0.009; p (PPC2) = 0.005; p (PPC3) = 0.007). CONCLUSIONS: Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.
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Reference Type(s) Journal Article
Topic Tag(s) Cost and Reimbursement;Defining/Evaluating/Qualifying a Medical Home;Outcomes;Implementation;Practice Facilitation
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