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Patient-Centered 'Medical Home' Models Lag in Key Areas

Efforts to put primary-care docs in charge of treatments face hurdles, study finds

WEDNESDAY, Sept. 10, 2008 (HealthDay News) -- Many large physician groups in the United States lack the essential elements needed to create patient-centered "medical homes" designed to put primary-care doctors in charge of coordinating care, says a new study.

The medical home model is seen by many health-care providers, businesses and patients as a promising way to address problems with the country's health-care delivery system. It's believed that comprehensive primary care can ensure the best outcomes for patients.

But this study of large medical groups with at least 20 physicians found that the practices are lagging in key areas needed to created a medical home.

Between March 2006 and March 2007, researchers at the University of California, San Francisco, the University of California at Berkley, and the University of Chicago surveyed all large physician practices across the United States that treat patients with asthma, diabetes, congestive heart failure and depression.

The researchers focused vital elements of the medical home model: whether physicians work closely with other health-care providers in patient care teams; how well care is coordinated and integrated; whether care is delivered in ways that maximize quality and safety; and whether patients can reach physicians by e-mail or other nontraditional ways.

The use of electronic medical records, disease registries, patient reminders, performance feedback and distribution of educational materials to patients was also examined in the study.

Certain components of the medical home model were more common than others. For example, 41 percent of the medical groups in the study use electronic medical records with basic functionalities, and just over half share information electronically with hospitals and specialists. But fewer than one-third rely on primary-care teams to deliver care. And while about two-thirds of the medical groups distribute guidelines about proper care for patients with chronic diseases, only 10 percent achieved high scores in the use of patient feedback to improve their practices.

Overall, the largest medical groups in the study (those with more than 140 physicians) and those owned by a hospital or health maintenance organization (HMO) scored highest on the four critical areas of a medical home model. This may be because they have more resources to invest, the study authors said.

"The medical home model holds great promise for the transformation of primary care, but this transformation won't happen overnight," study lead author Dr. Diane Rittenhouse, an assistant professor at the UCSF School of Medicine said in a news release. "Medical groups are being asked to make fundamental changes in the way they deliver care and make up-front investments in electronic systems and personnel, which are not routinely compensated."

The study was published in the September/October issue of Health Affairs.

More information

The Patient-Centered Primary Care Collaborative has more about the patient-centered medical home model.

SOURCE: Health Affairs, news release, Sept. 10, 2008
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