Sinaiko Anna D, Landrum Mary Beth, Meyers David J, Alidina Shehnaz, Maeng Daniel D, Friedberg Mark W, Kern Lisa M, Edwards Alison M, Flieger Signe Peterson, Houck Patricia R, Peele Pamela, Reid Robert J, McGraves-Lloyd Katharine, Finison Karl, Rosenthal Meredith B
Anna D. Sinaiko is a research scientist in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
Mary Beth Landrum is a professor of biostatistics in the Department of Health Care Policy at Harvard Medical School, in Boston.
Health Aff (Millwood). 2017 Mar 1;36(3):500-508. doi: 10.1377/hlthaff.2016.1235.
The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures. The initiatives were associated with a 1.5 percent reduction in the use of specialty visits and a 1.2 percent increase in cervical cancer screening among all patients, and a 4.2 percent reduction in total spending (excluding pharmacy spending) and a 1.4 percent increase in breast cancer screening among higher-morbidity patients. These associations were significant. Identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.
以患者为中心的医疗之家（PCMH）模式强调全面、协调、以患者为中心的护理，目标是降低成本并提高质量。为评估PCMH举措对医疗服务利用、成本和质量的影响，我们对11项主要PCMH举措评估中方法学标准化的结果进行了荟萃分析。在许多结果方面，各个评估之间存在显著异质性。在各项评估中，PCMH举措与所研究的大多数结果变化无关，包括初级保健、急诊科和住院就诊以及四项质量指标。这些举措与专科就诊使用减少1.5%以及所有患者宫颈癌筛查增加1.2%相关，与高发病率患者总支出（不包括药房支出）减少4.2%以及乳腺癌筛查增加1.4%相关。这些关联具有显著性。确定PCMH中可能改善结果的组成部分对于在初级保健领域投入资源的决策至关重要。
