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A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Transition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices.

OBJECTIVE

To test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2–10 providers) primary care practices over 2 years.

DESIGN

Randomized Controlled Trial.

PARTICIPANTS

Eighteen supported practices (intervention) and 14 control practices (controls).

INTERVENTIONS

Intervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance’s (NCQA) Physician Practice Connections® ─Patient-Centered Medical Home™ (PPC®-PCMH™) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC®-PCMH™.

MAIN MEASURES

PPC®-PCMH™ at baseline and 18 months, plus intervention at 7 months.

KEY RESULTS

At 18 months, 5 % of intervention practices and 79 % of control practices were not recognized by NCQA; 10 % of intervention practices and 7 % of controls achieved PPC®-PCMH™ Level 1; 5 % of intervention practices and 0 % of controls achieved PPC®-PCMH™ Level 2; and 80 % of intervention practices and 14 % of controls achieved PPC®-PCMH™ Level 3. Intervention practices were 27 times more likely to improve PPC®-PCMH™ by one level, irrespective of practice size (p < 0.001) 95 % CI (5–157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect (p time7 = 0.01), which was twice as large as the sustained effect over subsequent 12 months (p time18 = 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC®-PCMH™ standards over time (p time x group = 0.03). Intervention practices improved eight of nine standards, controls improved three of nine (p PPC1 = 0.009; p PPC2 = 0.005; p PPC3 = 0.007).

CONCLUSIONS

Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.

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Acknowledgments

The Commonwealth Fund supported the independent evaluation of this demonstration by the Ethel Donaghue Center for Translating Research into Practice and Policy (TRIPP Center) at the University of Connecticut Health Center. The full trial protocol can be accessed by contacting EmblemHealth.

Conflict of Interest

Judith Fifield, PhD, reports having received two honoraria from Zimmer in the last 3 years. All other authors declare they have no conflict of interest.

Author information

Authors and Affiliations

  1. University of Connecticut Health Center, Farmington, CT, USA

    Judith Fifield PhD, Deborah Dauser Forrest PhD, Melanie Martin-Peele MA, Joseph A. Burleson PhD, Jeanette Goyzueta MPH & Marco Fujimoto BS

  2. EmblemHealth, New York, NY, USA

    William Gillespie MD

  3. Ethel Donaghue TRIPP Center, 263 Farmington Ave. MC6229, Farmington, CT, 06030, USA

    Judith Fifield PhD, Deborah Dauser Forrest PhD, Melanie Martin-Peele MA, Jeanette Goyzueta MPH & Marco Fujimoto BS

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  1. Judith Fifield PhD
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  2. Deborah Dauser Forrest PhD
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Correspondence to Judith Fifield PhD.

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Fifield, J., Forrest, D.D., Martin-Peele, M. et al. A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices. J GEN INTERN MED 28, 770–777 (2013). https://doi.org/10.1007/s11606-012-2197-z

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  • DOI: https://doi.org/10.1007/s11606-012-2197-z

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