This paper commissioned by the Agency for Healthcare Research and Quality and prepared by Mathematica Policy Research reviews the published literature for evidence of the impact of establishing patient-centered medical homes on quality of care, costs, patient and caregiver experience, and health professional experience. The researchers reviewed 498 studies published between January 2000 and September 2010.
Reflecting the time required to evaluate and publish findings on the model, the interventions most often cited in support of the medical home can be viewed as precursors to the medical home. While the interventions varied, most essentially tested the addition of a care manager operating from within the primary care practice rather than a fundamentally transformed practice. Most interventions were evaluated in practices that were part of larger delivery systems and targeted patients who were older and sicker than average.
Turning to the evaluations, less than half assessed all triple aim outcomes. Evaluations of 6 of the 12 interventions provide rigorous evidence on one or more outcomes. This evidence indicates some favorable effects on all three triple aim outcomes, a few unfavorable effects on costs, and mostly inconclusive results (because of insufficient sample sizes to detect effects that exist or uncertain statistical significance of results because analyses did not account for clustering of patients within practices).
Ignatius Bau 