The Medical Home: What Do We Know, What Do We Need to Know? A Review of the Earliest Evidence on the Effectiveness of the Patient-Centered Medical Home Model
Prepared For: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850, www.ahrq.gov
Contract Numbers: HHSA290200900019I/HHSA29032002T, HHSA290200900019I/HHSA29032005T
Prepared By: Mathematica Policy Research, Princeton, NJ; Aparajita Zutshi, Ph.D., Deborah Peikes, Ph.D., M.P.A., Kimberly Smith, Ph.D., M.P.A., Melissa Azur, Ph.D. (Mathematica Policy Research), Janice Genevro, Ph.D., Michael Parchman, M.D., David Meyers, M.D. (Agency for Healthcare Research and Quality).
|Intervention||Favorable||Unfavorable||Not Statistically Significant||Uncertain Statistical Significance|
Notes: A result is considered statistically significant if p<0.05. The effects reported here are point estimates; the true effects can lie anywhere within the confidence intervals around these estimates, and may well be different from the point estimate. We do not include the confidence intervals because not all studies reported them.
aBecause the statistical significance of findings on the odds of hospital use in the CMP evaluation did not take clustering into account, we made this adjustment by using ICC estimates from the literature. However, we found that the statistical significance of these findings was sensitive to the estimate of ICC used; the findings remained significant when some estimates of ICC were used but lost their significance when other estimates were used. Therefore, we consider the statistical significance of these findings to be uncertain.
bThe p-values for findings on hospital stays for the GRACE evaluation were adjusted for clustering using a range of estimates of the intracluster correlation (ICC) from the literature. The findings remained statistically significant after the adjustment.
|Geriatric Resources for Assessment and Care of Eldersa||Year 1; |
Year 2: Odds of hospitalization among all patients and patients without diabetes
|Year 1; |
Year 2: Odds of hospitalization among patients with diabetes
|Geriatric Resources for Assessment and Care of Eldersb||Year 2: Reduced number of stays by 44% among high-risk (high PRA score) patients |
Year 3: Number of stays among all patients and high-risk (high PRA score) patients
|Year 1: Number of stays among all patients and high-risk (high PRA score) patients |
Year 2: Number of stays among all patients
|Guided Care||8 Months; |
20 Months: Number of stays
|Veterans Affairs Team-Managed Home-Based Primary Care||Months 1-6: Reduced number of readmissions by 22% among severely disabled patients||Months 1-6; |
Months 1-12: Proportion readmitted among all patients and severely disabled patients
Months 1-6: Number of readmissions among all patients
Months 1-12: Number of readmissions among all patients and severely disabled patients