Table AInclusion/exclusion criteria

Study CharacteristicInclusion CriteriaExclusion Criteria
Population
  • Adult primary care patients, selected to represent the practice rather than on the basis of a particular chronic illness.
  • Children with special health care needs according to the HRSA definition.
Studies where PCMH transformation was focused on a small proportion of patients being cared for in the practice; for example, studies restricted to patients with diabetes or asthma.
InterventionsKQs 1–3: A comprehensive PCMH intervention that includes items 1, 3, and 4, below, along with at least two components of item 2:
  1. Team-based care (team may be virtual).
  2. At least 2 of the following 4 components:
    1. Enhanced access to care
    2. Coordinated care across settings
    3. Comprehensiveness
    4. A systems-based approach to improving quality and safety
  3. A sustained partnership and personal relationship over time oriented toward the whole person.
  4. Structural changes to the traditional practice, reorganizing care delivery.
KQ 4: PCMH intervention should meet the above definition; however, because descriptions of ongoing studies were often sparse, we accepted the designation of “medical home” as meeting our intervention criteria without explicit documentation that the study truly met our functional definition.
KQs 1–3: Studies that were self-identified as pertaining to “medical home” but did not describe the intervention sufficiently to meet the AHRQ definition.
ComparatorsKQs 1–4:
  • Usual care
  • Programs aimed at improving the quality of care, process outcomes, or clinical outcomes that do not meet the operational definition of a comprehensive PCMH intervention (above).
KQ 4: For this question, we also accepted comparisons across different levels of PCMH implementation (high vs. low adopters).
KQs 1 and 4: No comparator. Analyses for KQs 2–3 include studies without comparators, while KQ 1 and KQ 4 analyses include only studies with comparison groups).
OutcomesKQ1: PCMH interventions may lead to a variety of effects on the health care system and patient health status. We prioritized and abstracted a specific subset of these outcomes that had face validity and were reported across studies, and/or were collected using validated instruments or methods. These included:
  1. Patient experiences:
    1. Global/overall patient experiences
    2. Coordination of care (as perceived by patients)
    3. Patient-provider interaction
  2. Staff experiences:
    1. Global/overall staff experiences
    2. Staff retention rates
    3. Staff burnout
  3. Process of care:
    1. Preventive services
    2. Chronic illness care services
  4. Clinical outcomes:
    1. Health status
    2. Laboratory tests
    3. Mortality
  5. Economic outcomes:
    1. Inpatient use
    2. Emergency department use
    3. Overall costs
  6. Unintended consequences or other harms
KQ 2: PCMH components as listed in the Interventions section.

KQ 3:
  1. Financial models.
  2. System change, along with any theoretical basis provided.
  3. Organizational learning strategies and any theoretical basis provided for these strategies.
KQ 4: (horizon scan of ongoing studies):
  1. Study design
  2. PCMH components
  3. Settings (e.g., practice size, geographic location)
  4. Financial models
  5. Outcomes assessed (if reported):
    1. Patient experiences
    2. Staff experiences
    3. Process of care
    4. Clinical outcomes
    5. Economic outcomes
No outcomes of interest reported.
TimingStudies had to have at least 6 months longitudinal followup.Less than 6 months longitudinal followup.
SettingPrimary care settings, e.g., family medicine, general internal medicine, primary care pediatrics, general medical clinics such as Federally Qualified Health Centers, general medical clinics primarily staffed by midlevel providers, general practices/practitioners, geriatric practices providing longitudinal care rather than consultative services.
KQ 1–3: Studies conducted in a high-income economya as defined by the World Bank.
KQ 4: Studies underway in the United States.b
  • Geriatric practices providing consultative services.
  • Medical subspecialties.
Study designKQ 1, KQ 4: Patient or cluster RCT, nonrandomized clustered controlled trial, controlled before-and-after study.
KQ 2, KQ 3: Patient or cluster RCT, nonrandomized clustered controlled trial, controlled before-and-after study, uncontrolled pre- and postintervention study.
Not a clinical study (e.g., editorial, nonsystematic review, letter to the editor, case series).
PublicationsKQs 1–4: English-language only.c
KQs 1–3:
  • Publication date from database inception to present.
  • Peer-reviewed article.
KQ 4: Studies had to be ongoing or scheduled to be completed on or after April 2010.d
  • Non-English-language publication.c
  • Not peer reviewed (e.g., letter to editor).
a

We restricted studies for KQs 1–3 to high-income economies—i.e., to countries that have greater cultural and health care system similarities to the United States—to improve applicability of the study results to the United States.

b

KQ 4 studies were restricted to those conducted in the United States to maximize applicability to our target audience and because our knowledge of gray literature sources is good within the United States but poor outside it.

c

We excluded non-English-language publications for two reasons: (a) we are most interested in health care systems that are similar to U.S. health care, and reports from these countries are likely to be published in English; and (b) it is the opinion of the investigators that the resources required for translation of non-English articles would not be justified by the low potential likelihood of identifying relevant data unavailable from English-language sources.

d

Our rationale was that studies completed prior to April 2010 should already have been published.

Notes: AHRQ = Agency for Healthcare Research and Quality; HRSA = Health Resources and Services Administration; KQ = Key Question; PCMH = patient-centered medical home; RCT = randomized controlled trial

From: Executive Summary

Cover of Closing the Quality Gap: Revisiting the State of the Science (Vol. 2: The Patient-Centered Medical Home)
Closing the Quality Gap: Revisiting the State of the Science (Vol. 2: The Patient-Centered Medical Home).
Evidence Reports/Technology Assessments, No. 208.2.
Williams JW, Jackson GL, Powers BJ, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.