Tuesday, October 6, 2009

Patient-Centered Medical Home Demo Improves Quality and Patient Sat

A demonstration project by Group Health found that the Patient-Centered Medical Home (PCMH) "redesign can be associated with improvements in patient experience, clinician burnout, and quality without increasing overall cost."

With PCMH, Group Health found that the patients' experience was rated higher on 6 out of 7 indicators without an increase in costs. "For staff burnout, 10% of PCMH staff reported high emotional exhaustion at 12 months compared with 30% of controls, despite similar rates at baseline. PCMH patients also had gains in composite quality between 1.2% and 1.6% greater than those of other patients. PCMH patients used more e-mail, phone, and specialist visits, but fewer emergency services. At 12 months, there were no significant differences in overall costs."

Prior to the PCMH demonstration project, Group Health had implemented access and efficiency improvements which increased patient satisfaction but also increase physician fatigue. The improvements had included "same-day appointment scheduling, direct access to some specialists, primary care redesign to enhance care efficiency, variable physician compensation (salaries with relative value unit [RVU] incentives), and an electronic medical record with a patient Web portal to enable patient e-mail, online medication refills, and record review. The reforms succeeded in improving patient access and satisfaction, but also increased physician workload, as evidenced by larger panel sizes, greater resource intensity per face-to-face visit, and increasing adoption of patient e-mail. These workload changes, combined with the implementation of the electronic medical record, resulted in fatigue and decreased work satisfaction. Relative reductions also were seen in nationally reported quality-of-care indicators as well as downstream utilization increases in specialty care, emergency care, and inpatient days."

The implementation of the Patient-Centered Medical Home was organized around the relationship between the primary care physician and the patient. The primary care physician leads the clinical team and coordinates the planning of care with the patient. "Maximum use of technology" facilitates patient access.

Group Health implemented changes related to the structure of the care teams, point-of-care, patient outreach and management. Changes included "the use of team huddles, previsit outreach and chart review, and use of patient-centered quality deficiency reports. The PCMH clinic emphasized both e-mail and telephone encounters (as an alternative or complement to in-person visits), depending on patient abilities and preferences."

As a result of its success, Group Health is expanding its Patient-Centered Medical Home program to all of its centers.

No comments: