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

March 2013
AHRQ Publication No. 12(14)-0020-1-EF
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).

Table 4.1. Evaluations with ratings of high or moderate on at least one outcome
InterventionEvaluation DesignEvidence Rating: OutcomePrimary Rationale

Note: The attrition criterion for RCTs accounts for both overall attrition and differential attrition between the intervention and control groups.

aThe main evaluation design was a cluster randomized, controlled trial, but health care professional experience was examined only for intervention group providers using a cross-sectional study.
bThe main evaluation design was a randomized, controlled trial, but health care professional experience was examined only for intervention group providers using a pre-post study.

Care Management PlusComparison group designModerate: Hospital use and emergency department (ED) use, process of care measures, and mortalityIntervention and comparison groups had equivalent outcomes at baseline and the study controlled for baseline values of the outcome
Geisinger Health System ProvenHealth NavigatorComparison group designModerate: Hospital UseIntervention and comparison groups had equivalent outcomes at baseline and the study controlled for baseline values of the outcome
Low: CostsIntervention and comparison groups did not have equivalent values of the outcome at baseline
Geriatric Resources for Assessment and Care of EldersCluster RCTaHigh: Health outcomes; mortality; costs, hospital use, and ED use; 18 of 19 process of care measuresRCT with low attrition at followup and no reported statistically significant baseline differences in the outcomes
Low: 1 of 19 process of care measures (followup primary care visit occurred within 6 weeks of hospital discharge)Outcome based on an endogenous subgroup (those with a hospitalization in the first year of the intervention)
Low: Health care professional experienceEvaluation design prevents attribution of changes in the outcome to the intervention rather than other factors
Guided CareCluster RCTHigh: Costs, hospital use, and ED use; patient experience of care outcomes; caregiver experience of care outcomesRCT with low attrition and no reported statistically significant baseline differences in the outcomes
Moderate: Health care professional experienceRCT with high attrition but intervention and control group samples at followup had equivalent values of the outcome at baseline and study controlled for baseline values of the outcome
Improving Mood–Promoting Access to Collaborative Treatment for Late-Life DepressionRCTbHigh: Health outcomes; process of care outcomes; patient experience of care at 3 and 12 months; costsRCT with low attrition and no reported statistically significant baseline differences in the outcomes
Low: Patient experience of care at 18 and 24 monthsOutcome based on endogenous subgroup (those reporting depression care in the past 6 months)
Low: Health care professional experienceEvaluation design prevents attribution of changes in the outcome to the intervention rather than other factors
Veterans Affairs Team-Managed Home-Based Primary CareRCTHigh: Hospital use; costs; for subgroup of nonterminally ill patients—health outcomes and patient and caregiver experience of careRCT with low attrition and no reported statistically significant baseline differences in the outcomes
Low: For subgroup of terminally ill patients—patient and caregiver health outcomes; patient and caregiver experience of careRCT with high attrition among terminally ill patients; study does not report if the intervention and control group samples at followup had equivalent outcomes at baseline