Blog | Wednesday, June 4, 2014

QD: News Every Day--Better care in PCMH may stem from culture changes, not from technology


Patient-centered medical homes (PCMH) improve care quality at a significantly higher rate than their non-PCMH peers regardless of whether the comparison practices used paper or electronic health records (EHRs), a study found.

Research published in Annals of Internal Medicine concluded that the odds of patients receiving recommended care over time in the medical home were considerably higher.

Lead author Lisa Kern, MD, MPH, FACP, and colleagues followed 675 primary care physicians (about half were internists) in 3 groups in New York’s Hudson Valley region for 3 years to test their progress improvement on 10 industry-recognized primary care quality measures. The ongoing study is a collaboration of Taconic Health Information Network and Community (THINC), a not-for-profit coalition-building organization; the Taconic Independent Practice Association (IPA), a not-for-profit physician organization; and MedAllies, a for-profit health information services provider. It was funded by the Commonwealth Fund and the New York State Department of Health.

The PCMH group improved significantly more over time than either the paper group or the EHR group for 4 of the 10 measures (by 1 to 9 percentage points per measure): eye examinations and hemoglobin A1c testing for patients with diabetes, chlamydia screening, and colorectal cancer screening (adjusted P<0.05 for each). The odds of overall quality improvement in the PCMH group were 7% higher than in the paper group and 6% higher than in the EHR group (adjusted P<0.01 for each).

Of note, the practices studied were larger, and tended to be “ready” to become PCMHs because they had more resources to implement changes. Also, while none of the culture changes specifically hinge upon having an HER, some of them are aided by using such a system. So the results suggest a combined effect is possible.

The authors wrote, “The PCMH is a multicomponent intervention, and it is not possible from this study to determine the mechanism by which the PCMH might have improved quality. Of note, however, this study evaluated the effect of the PCMH separately from that of the EHR. The intervention group composed PCMH physicians, all of whom reached NCQA level 3 and used EHRs; indeed, achieving level 3 without EHRs is difficult. The results of this study therefore suggest that level 3 PCMH is more than a health information technology intervention; changes to organizational culture seem to play a role.”