Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

The Patient-Centered Medical Home (PCMH) has been speedily adopted as a solution to our fragmented, specialist-heavy health care system. Careful evaluation of PCMH outcomes, such as those presented in the recent Annals supplement, are necessary to understand the benefits and shortcomings of this system innovation.

A notable cautionary finding in this assessment is that there were “no significant improvements in patient-rated outcomes, including ratings of the 4 pillars of primary care (easy access to first-contact care, comprehensive care, coordination of care, and personal relationship over time), global practice experience, patient empowerment, and self-rated health status.” This finding points to an important difference between a PCMH and “personal doctoring,” the foundational concept of family medicine.

As Fox defined in 1960, personal doctoring is “to take full responsibility for patients and form a strong personal relationship with them.” Ideally, the components of a PCMH would enable personal doctoring; these early findings are not encouraging. The authors note several possible reasons for the flat (trending toward negative for some outcomes) patient-rated outcomes, including the potentially distracting nature of an electronic medical record (EMR) or the emotionally exhausting process of large systemic change.

Fox cautioned, “The truth, I fancy, is that a large group can hardly ever perform a personal function really well.” We must ensure that the system of PCMH does not supplant or impede the primacy of the patient-doctor relationship.

1. Jaen et al. Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project. Annals of FM. 8(1): S57. 2010.

2. Fox TF. The Personal Doctor and His Relation to the Hospital; Observations and Reflections on Some American Experiments in General Practice by Groups. The Lancet; Apr 2, 1960.

Competing interests:   None declared