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J Gen Intern Med. 2013 Jun;28(6):770-7. doi: 10.1007/s11606-012-2197-z. Epub 2012 Sep 7.

A randomized, controlled trial of implementing the patient-centered medical home model in solo and small practices.

Author information

  • 1University of Connecticut Health Center, Farmington, CT, USA. fifield@nso1.uchc.edu

Abstract

BACKGROUND:

Transition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices.

OBJECTIVE:

To test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2-10 providers) primary care practices over 2 years.

DESIGN:

Randomized Controlled Trial.

PARTICIPANTS:

Eighteen supported practices (intervention) and 14 control practices (controls).

INTERVENTIONS:

Intervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance's (NCQA) Physician Practice Connections(®)-Patient-Centered Medical Home™ (PPC(®)-PCMH™) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC(®)-PCMH™.

MAIN MEASURES:

PPC(®)-PCMH™ at baseline and 18 months, plus intervention at 7 months.

KEY RESULTS:

At 18 months, 5 % of intervention practices and 79% of control practices were not recognized by NCQA; 10% of intervention practices and 7% of controls achieved PPC(®)-PCMH™ Level 1; 5% of intervention practices and 0% of controls achieved PPC(®)-PCMH™ Level 2; and 80% of intervention practices and 14% of controls achieved PPC(®)-PCMH™ Level 3. Intervention practices were 27 times more likely to improve PPC(®)-PCMH™ by one level, irrespective of practice size (p < 0.001) 95% CI (5-157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect (p(time7) = 0.01), which was twice as large as the sustained effect over subsequent 12 months (p(time18) = 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC(®)-PCMH™ standards over time (p(time x group)=0.03). Intervention practices improved eight of nine standards, controls improved three of nine (p(PPC1) = 0.009; p(PPC2) = 0.005; p(PPC3) = 0.007).

CONCLUSIONS:

Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.

Comment in

PMID:
22956444
[PubMed - indexed for MEDLINE]
PMCID:
PMC3663952
Free PMC Article

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