The patient-centered medical home (PCMH) is not a pill. It would be much easier to evaluate this primary care reform if it were.
In this issue of JAMA Internal Medicine, Rosenthal et al1 report their evaluation of the pilot program of a patient-centered medical home model of primary care at 5 practices supported by a consortium of 3 Rhode Island health insurance plans. Findings on patient outcomes were mixed. During the 2-year postintervention period, patients in the pilot practices had 11.6% fewer emergency department visits that were potentially avoidable compared with matched control patients in other practices, with a nonsignificant decrease of 5.2% in total emergency department visits. A similar trend was observed for hospital admissions, with nonsignificant decreases of 15.1% for potentially avoidable admissions and 2.9% for total admissions. No significant differences were found in diabetes care and cancer screening, although colon cancer screening rates increased by a sizable but not significant 37% during the postintervention period.
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