Primary care doctors practicing in a model of coordinated, team-based care that leverages health information technology are more likely to give patients recommended preventive screening and appropriate tests than physicians working in other settings, according to research published in the Annals of Internal Medicine. The study comparing quality of care by physicians using the patient-centered medical home (PCMH) model to care from physicians in non-PCMH practices provides evidence that the previously unproven but popular model effectively provides care for patients.
In 2012, there were more than 90 commercial health plans, 42 states, and three federal initiatives testing the PCMH model. Although a PCMH could operate without electronic health records (EHRs), the technology has been shown to improve communication among providers, patients and their care teams. It keeps patients better informed about their health and guides providers' medical decision-making.
The study evaluated healthcare in New York's Hudson Valley where providers and payers operate independently. Researchers examined how care quality changed over three years (from 2008 to 2010) in 13 primary care practices that used EHRs and became PCMHs over the course of the study, compared with 64 practices that used EHRs but were not PCMHs and 235 non-PCMH practices that used paper-based systems to store patient health information.
The researchers compared medical claims from more than 140,000 commercially insured patients across 10 quality measures, such as eye exams, hemoglobin A1C testing to monitor blood-glucose levels, and lipid testing for patients with diabetes; breast cancer and colorectal cancer screening; and recommended tests for children with sore throats. They found that, over time, physician practices using the PCMH model scored between 1 and 9 percentage points higher than did non-PCMH practices on four of the 10 measures. Overall, the likelihood of receiving recommended care in PCMHs was 6 percent higher than in the group that used EHRs and 7 percent higher than in the group that used paper records.
The PCMH effect was independent of EHR technology, which, on its own, seemed to be insufficient to achieve improvements in care. The authors suggest that changes to organizational culture necessitated by the PCMH seem to play a role in improving quality of care. PCMHs require providers to become accountable for their performance, build teams by defining roles and responsibilities, and manage patient groups or populations rather than individuals. While none of those changes focus specifically on information technology, IT makes at least two—population management and performance accountability—easier for providers to achieve.
