Patient-Centered Medical Home A Systematic Review

被引:515
作者
Jackson, George L.
Powers, Benjamin J.
Chatterjee, Ranee
Bettger, Janet Prvu
Kemper, Alex R.
Hasselblad, Vic
Dolor, Rowena J.
Irvine, Julian
Heidenfelder, Brooke L.
Kendrick, Amy S.
Gray, Rebecca
Williams, John W., Jr.
机构
[1] Durham Vet Affairs Med Ctr, Durham, NC USA
[2] Duke Univ, Sch Med, Durham, NC 27710 USA
[3] Duke Univ, Sch Nursing, Durham, NC 27710 USA
关键词
OUTPATIENT GERIATRIC EVALUATION; HEALTH-CARE NEEDS; QUALITY-OF-CARE; GUIDED CARE; YOUNG-CHILDREN; OLDER PERSONS; MANAGEMENT; MODEL; COST; OUTCOMES;
D O I
10.7326/0003-4819-158-3-201302050-00579
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The patient-centered medical home (PCMH) describes mechanisms for organizing primary care to provide high-quality care across the full range of individuals' health care needs. It is being widely implemented by provider organizations and third-party payers. Purpose: To describe approaches for PCMH implementation and summarize evidence for effects on patient and staff experiences, process of care, and clinical and economic outcomes. Data Sources: PubMed (through 6 December 2011), Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Database of Systematic Reviews (through 29 June 2012). Study Selection: English-language trials and longitudinal observational studies that met criteria for the PCMH, as defined by the Agency for Healthcare Research and Quality, and included populations with multiple conditions. Data Extraction: Information on study design, populations, interventions, comparators, financial models, implementation methods, outcomes, and risk of bias were abstracted by 1 investigator and verified by another. Data Synthesis: In 19 comparative studies, PCMH interventions had a small positive effect on patient experiences and small to moderate positive effects on the delivery of preventive care services (moderate strength of evidence). Staff experiences were also improved by a small to moderate degree (low strength of evidence). Evidence suggested a reduction in emergency department visits (risk ratio [RR], 0.81 [95% CI, 0.67 to 0.98]) but not in hospital admissions (RR, 0.96 [CI, 0.84 to 1.10]) in older adults (low strength of evidence). There was no evidence for overall cost savings. Limitation: Systematic review is challenging because of a lack of consistent definitions and nomenclature for PCMH. Conclusion: The PCMH holds promise for improving the experiences of patients and staff and potentially for improving care processes, but current evidence is insufficient to determine effects on clinical and most economic outcomes. Ann Intern Med. 2013;158:169-178.
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页码:169 / +
页数:28
相关论文
共 93 条
[1]  
Agency for Healthcare Research and Quality, 2012, CLOS QUAL GAP REV ST
[2]  
[Anonymous], PAT CTR MED HOM HIST
[3]  
[Anonymous], 2001, CROSS QUAL CHASM NEW
[4]  
[Anonymous], METH GUID EFF COMP E
[5]   Making Good on ACOs' Promise - The Final Rule for the Medicare Shared Savings Program [J].
Berwick, Donald M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (19) :1753-1756
[6]   A Nationwide Survey of Patient Centered Medical Home Demonstration Projects [J].
Bitton, Asaf ;
Martin, Carina ;
Landon, Bruce E. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2010, 25 (06) :584-592
[7]   Primary care - Will it survive? [J].
Bodenheimer, Thomas .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (09) :861-864
[8]   Early effects of "Guided care" on the quality of health care for multimorbid older persons: A cluster-randomized controlled trial [J].
Boult, Chad ;
Reider, Lisa ;
Frey, Katherine ;
Leff, Bruce ;
Boyd, Cynthia M. ;
Wolff, Jennifer L. ;
Wegener, Stephen ;
Marsteller, Jill ;
Karm, Lya ;
Scharfstein, Daniel .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2008, 63 (03) :321-327
[9]   The Effect of Guided Care Teams on the Use of Health Services Results From a Cluster-Randomized Controlled Trial [J].
Boult, Chad ;
Reider, Lisa ;
Leff, Bruce ;
Frick, Kevin D. ;
Boyd, Cynthia M. ;
Wolff, Jennifer L. ;
Frey, Katherine ;
Karm, Lya ;
Wegener, Stephen T. ;
Mroz, Tracy ;
Scharfstein, Daniel O. .
ARCHIVES OF INTERNAL MEDICINE, 2011, 171 (05) :460-466
[10]   Guided care for multimorbid older adults [J].
Boyd, Cynthia M. ;
Boult, Chad ;
Shadmi, Efrat ;
Leff, Bruce ;
Brager, Rosemarie ;
Dunbar, Linda ;
Wolff, Jennifer L. ;
Wegener, Stephen .
GERONTOLOGIST, 2007, 47 (05) :697-704