Yet another report showing lackluster quality improvement in physician practices certified as patient centered medical homes—after three years of concerted effort—sparks the question: why is it so difficult to get better results?
The report, published in Wednesday's Journal of the American Medical Association, compared quality, utilization, and costs of care delivered to about 120,000 patients in 32 Pennsylvania practices. About half of the patients were treated by physicians in PCMHs certified or recognized by the National Committee for Quality Assurance; the others were treated by physicians in traditional practices.
The 2008–2011 report found that compared with traditional practices, recognized NCQA PCMHs did no better at controlling costs, or on 10 of 11 quality measures evaluated, such as cholesterol testing and cervical cancer screening, or in avoiding emergency room visits of patients who could have been seen in an ambulatory setting.
The only measure where some improvement was seen in the medical home groups was in nephropathy screening for kidney disease in patients with diabetes.
Though these pilot practices were able to achieve NCQA certification and adopted registries designed to identify patients in need of certain chronic disease services, that didn't result in fewer patients making trips to the emergency department or fewer patients getting admitted to the hospital.