Medical home principles can help coordinate care: Commonwealth survey

The medical care of patients with complex needs is often poorly coordinated across the globe, but the use of medical home principles can counteract that, according to a survey of patients in 11 countries with diverse models of providing and financing care.

The survey of more than 18,000 sicker adults—conducted on behalf of the Commonwealth Fund by Harris Interactive—found that the percentage of patients experiencing a coordination gap in the last two years ranged from a high of 56% in Germany and a low of 20% in the U.K. In the U.S., 42% of patients reported having such a gap. The survey was scheduled to be posted online Nov. 10 and in the December issue of Health Affairs.

“To varying degrees, care is often poorly coordinated,” said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund, at a news telebriefing.

But the results also indicate that the use of medical homes reduced that lack of coordination and helped in other ways, said Commonwealth Fund researchers. “Having a medical home makes a difference; it makes a difference in every country,” Schoen said in reference to findings indicating medical homes help patients in such areas as medical errors, medication and lab test errors, and in patient perception of quality.

Robin Osborn, vice president and director of the Commonwealth Fund's International Program in Health Policy and Innovation, said that medical homes improved care across different types healthcare systems, noting that two of the better performers, the U.K. and Switzerland, have different approaches.

The survey found the U.S. to fare poorly in terms of cost of care with the country ranked last in terms of percentage of respondents who went without care because of cost in the past year, at 42%.

Patients were surveyed between March and June in: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. Included were people who reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury or disability in the past year, according to a news release. The study identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible, and helps coordinate care received from other providers, according to the release.