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Primary-care group faults medical-homes analysis


By Andis Robeznieks
Posted: December 3, 2012 - 12:30 pm ET
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The Patient Centered Primary Care Collaborative is criticizing an Annals of Internal Medicine report that concluded there wasn't enough evidence to determine the patient-centered medical-home practice model's effect on clinical outcomes and costs. The collaborative asserts that the report overlooks more recent studies that "tell a far more encouraging story."

The journal study, funded by the HHS' Agency for Healthcare Research and Quality, identified some 5,731 studies for analysis, but its authors found only 19 that contained the effectiveness data the researchers sought. But, according to a news release from the PCPCC, more current research available now offers more-conclusive evidence of the model's cost-effectiveness and shows that "medical-home transformation is a journey that requires patience and leadership."

"While we are pleased that increasing attention is being paid to the medical home and its impact on quality and costs, we must recognize first and foremost that success requires transformative efforts," Marci Nielsen, PCPCC CEO, said in the news release. "This transformation requires upfront investment of time and resources, staff and workforce training, adoption of health IT, monitoring of patient outcomes and new payment models. To expect short-term cost savings and health improvements sets unrealistic expectations for an already overlooked primary-care sector that is essential to strengthening our costly and inefficient healthcare system."

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Last December, AHRQ criticized the research being done on medical homes. It noted that many studies lacked a control group, and it described as "poor" the evidence coming from studies that used data generated both before and after an intervention. It also asserted that many early studies were done using practices that could be called "precursors" to medical homes.

The PCPCC acknowledged this in its news release. The group said it agrees with the Annals of Internal Medicine report's authors that "medical home evaluations require more rigor and consistent definitions," but also cited a Health Affairs report on a Colorado medical-home pilot that saw savings through reduced emergency department visits and hospitalizations among patients with chronic disease.

The PCPCC is a Washington-based advocacy organization with some 1,000 member organizations.


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