NLM Director’s Comments Transcript
Improving

Patient Centered Medical Homes: 05/05/2014

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Photo: Courtesy of Rob Logan.

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

I’m Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine, for Donald Lindberg, M.D, the Director of the National Library of Medicine.

Here is what’s new this week in MedlinePlus.

Recent findings that patient centered medical homes do not result in expected clinical outcomes could be countered by a more strategic evaluation of patient uses and needs, suggests a comprehensive study and an insightful, accompanying editorialpublished in the Journal of the American Medical Association.

The study of 32 small and medium sized community-based clinical practices that set up a patient centered medical home (compared to 29 settings where primary care occurred without it), suggests medical homes comparatively do not reduce patient utilization of ambulance services, as well as use of overall hospital care and a clinical center’s emergency department. The reduced use of these services was anticipated as some of the cost savings derived from promoting patient centered medical homes.

The study also found patient centered medical homes comparatively did not result in an improvement in 10 of 11 clinical measures that were seen as a probable benefit of the intervention. For example, the study found patient centered medical homes did not make a comparatively significant difference in improving patient colorectal, cervical, and breast cancer screening. The intervention of a patient centered medical home did not increase eye examinations, and failed to boost patient cholesterol screening and improve their cholesterol levels.

The Agency for Healthcare Research and Quality (AHRQ) explains a patient centered medical home provides a comprehensive model of care that intends to do more than redirect clinical assistance from a health care providers office to one’s residence. AHRQ explains a patient centered medical home seeks to provide comprehensive, coordinated care without sacrificing care quality and provider access.

The author of the editorial accompanying the study notes patient centered medical homes (and we quote): ‘have been proposed to result in enhanced access for routine primary care, improved delivery of preventive services, high-quality disease management, and reduced emergency department and hospital utilization’ (end of quote).

While acknowledging the study’s disappointing findings, the editorial’s author explains they reveal less about the inabilities of patient centered medical homes to reach their potential than a need to focus on providing home care to those who are most likely to benefit from a residence-based intervention. The editorial’s author notes patient centered medical homes were promoted (and we quote) ‘even before being fully developed in high targeted high-risk populations or before clearly understanding which features or combination of features are most effective with which patients’ (end of quote).

To improve the intervention’s efficacy, the editorial’s author writes (and we quote): ‘it is time to replace enthusiasm and promotion with scientific rigor and prudence and to better understand what the (patient centered medical home) is and is not’ (end of quote).

The editorial’s author adds the next phase of patient centered medical home development should focus on patients with an array of clinical needs, who require expensive and time-consuming care, instead of targeting home care to persons with specific diseases. More specifically, the author concludes patient centered medical homes should be developed and assessed among patients with multiple chronic diseases or conditions, accompanying mental illnesses, and a lack of social support.

Meanwhile, a guide to contemporary home health care (provided by the Administration on Aging) is available in the ‘start here’ section of MedlinePlus.gov’s home care services health topic page.

Answers to basic questions about home health care (from the Mayo Foundation for Medical Education and Research) is provided in the ‘overviews’ section of MedlinePlus.gov’s home care services health topic page. An updated, helpful overview of what to expect from home health care (from the Centers for Medicare & Medicaid Services) also is available in the ‘overviews’ section of MedlinePlus.gov’s home care services health topic page.

A practical home health care website (from the National Association for Home Care & Hospice) provides billing and payment background information within the ‘related issues’ section of MedlinePlus.gov’s home care services health topic page.

MedlinePlus.gov’s home care services health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about home care services as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s home care services health topic page type ‘home care services’ in the search box on MedlinePlus.gov’s home page, then, click on ‘home care services (National Library of Medicine).’ MedlinePlus.gov also has health topic pages on assisted living and caregivers.

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Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov

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A written transcript of recent podcasts is available by typing 'Director's comments' in the search box on MedlinePlus.gov's home page.

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A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.