Ann Intern Med. 2013 Feb 5;158(3):169-78. doi: 10.7326/0003-4819-158-3-201302050-00579.
The patient-centered medical home (PCMH) describes mechanisms for organizing primary care to provide high quality care across the full range of individuals' health care needs.It is being widely implemented by provider organizations and third party payers.
To describe approaches for PCMH implementation and summarize evidence for effects on patient and staff experiences,process of care, and clinical and economic outcomes.
PubMed (through 6 December 2011), Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Database of Systematic Reviews (through 29 June 2012).
English-language trials and longitudinal observational studies that met criteria for the PCMH, as defined by the Agency for Healthcare Research and Quality, and included populations with multiple conditions.
Information on study design, populations, interventions,comparators, financial models, implementation methods,outcomes, and risk of bias were abstracted by 1 investigator and verified by another.
In 19 comparative studies, PCMH interventions had a small positive effect on patient experiences and small to moderate positive effects on the delivery of preventive care services(moderate strength of evidence). Staff experiences were also improved by a small to moderate degree (low strength of evidence).Evidence suggested a reduction in emergency department visits(risk ratio [RR], 0.81 [95% CI, 0.67 to 0.98]) but not in hospital admissions (RR, 0.96 [CI, 0.84 to 1.10]) in older adults (low strength of evidence). There was no evidence for overall cost savings.
Systematic review is challenging because of a lack of consistent definitions and nomenclature for PCMH.
The PCMH holds promise for improving the experiences of patients and staff and potentially for improving care processes,but current evidence is insufficient to determine effects on clinical and most economic outcomes
以患者为中心的医疗之家（PCMH）描述了组织初级保健的机制，以提供各种个人医疗需求的高质量护理。它正被服务提供商组织和第三方支付者广泛实施。
描述 PCMH 实施的方法，并总结对患者和员工体验、护理过程以及临床和经济结果的影响的证据。
PubMed（截至 2011 年 12 月 6 日）、护理学和联合健康文献累积索引以及 Cochrane 系统评价数据库（截至 2012 年 6 月 29 日）。
符合医疗保健研究和质量局定义的 PCMH 标准的英语试验和纵向观察研究，并包括患有多种疾病的人群。
由一名调查员提取研究设计、人群、干预措施、对照、财务模型、实施方法、结果和偏倚风险等信息，并由另一名调查员验证。
在 19 项比较研究中，PCMH 干预措施对患者体验有较小的积极影响，对预防保健服务的提供有较小到中等程度的积极影响（证据力度中等）。员工体验也得到了较小到中等程度的改善（证据力度低）。证据表明，在老年患者中急诊就诊次数减少（风险比 [RR]，0.81 [95% CI，0.67 至 0.98]），但住院率没有降低（RR，0.96 [CI，0.84 至 1.10]）（证据力度低）。没有证据表明总体成本节约。
由于缺乏 PCMH 的一致定义和命名法，系统评价具有挑战性。
PCMH 有望改善患者和员工的体验，并且可能改善护理过程，但目前的证据不足以确定对临床和大多数经济结果的影响。
