Melinda Abrams, MS

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Evaluating Systems of the Patient-Centered
Medical Home
Agenda Item IV

• Melinda Abrams, MS
• The Commonwealth Fund
• Patient-Centered Primary Care Collaborative
  Stakeholders Workshop Meeting
• Washington, DC
• July 16, 2008
• www.commonwealthfund.org

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Why Are Evaluations Important?

• Considerable information suggests the
  patient-centered medical home will result in
  better quality, patient experience and greater
  efficiency
• However, gaps in the evidence exist
• Need to rigorously evaluate demonstrations to
  improve health care and health policy
• Need information that is useful to policymakers,
  purchasers, payers, clinicians and patients
• How many evaluations are enough?

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Patient-Centered Medical Home Evaluations Key
Research Questions

• Do Patient-Centered Medical Homes provide better
  clinical quality, patient experience and more
  efficient care?
• Does the degree a practice embrace PCMH
  principles correlate with these improvements?
• Do physician offices that receive technical
  assistance and revised payment structure improve
  their performance on measures of clinical
  quality, patient experience and efficiency?
• Are physician practices able to make the changes
  necessary to function as patient-centered medical
  homes?
• Do the processes or outcomes work any differently
  for safety net clinics or providers?

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Carlos Jaén, MD, PhD University of Texas Health
Science Center
Meredith Rosenthal, PhD Harvard School
of Public Health
Judith Fifield, PhD University of Connecticut
Health Center
Diane Rittenhouse, MD, MPH University of
California, San Francisco
Marshal Chin, MD University of Chicago Medical
Center
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Key Design Features In the commercial setting
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Key Design Features In the safety-net setting
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Comparison of Research Questions
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Comparison of Research Questions (continued)
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Comparison of MeasuresIn the commercial setting
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MeasuresIn the safety-net setting
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Challenges/ Concerns

• Complex interventions
• Short time horizons
• Small sample sizes
• Randomization challenges
• Standardizing measurement across pilot projects
• High level of enthusiasm among payers and
  employers
• Potentially underfinanced more funding partners
  needed

E. Schneider, M. Rosenthal, Another Chasm to
Cross? Evaluating the PCMH, presentation at
AcademyHealth Annual Research meeting,
invitational breakout session (June 2008).
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Considerations for Future Medical Home Evaluations

• What will we learn thats new?
• Need variation in demonstration design (e.g.,
  payment, TA)
• Multi-payer strongly preferred
• Standardization of metrics to enable
  cross-project comparisons
• Keeping patients at the center without patient
  perspective, its not a patient-centered medical
  home
• Co-funding
• Must assure independence of investigator to
  publish results regardless of outcome
• Robust design
• Clarity about implications for key audiences