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Melinda Abrams, MS

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... outcomes work any differently for safety net clinics or providers? ... Clinical. Modified NCQA PPC-PCMH. National Survey of Small and Medium Physician Practices ... – PowerPoint PPT presentation

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Title: Melinda Abrams, MS


1
Evaluating Systems of the Patient-Centered
Medical Home
Agenda Item IV
  • Melinda Abrams, MS
  • The Commonwealth Fund
  • Patient-Centered Primary Care Collaborative
    Stakeholders Workshop Meeting
  • Washington, DC
  • July 16, 2008
  • www.commonwealthfund.org

2
Why Are Evaluations Important?
  • Considerable information suggests the
    patient-centered medical home will result in
    better quality, patient experience and greater
    efficiency
  • However, gaps in the evidence exist
  • Need to rigorously evaluate demonstrations to
    improve health care and health policy
  • Need information that is useful to policymakers,
    purchasers, payers, clinicians and patients
  • How many evaluations are enough?

3
Patient-Centered Medical Home Evaluations Key
Research Questions
  • Do Patient-Centered Medical Homes provide better
    clinical quality, patient experience and more
    efficient care?
  • Does the degree a practice embrace PCMH
    principles correlate with these improvements?
  • Do physician offices that receive technical
    assistance and revised payment structure improve
    their performance on measures of clinical
    quality, patient experience and efficiency?
  • Are physician practices able to make the changes
    necessary to function as patient-centered medical
    homes?
  • Do the processes or outcomes work any differently
    for safety net clinics or providers?

4
Carlos Jaén, MD, PhD University of Texas Health
Science Center
Meredith Rosenthal, PhD Harvard School
of Public Health
Judith Fifield, PhD University of Connecticut
Health Center
Diane Rittenhouse, MD, MPH University of
California, San Francisco
Marshal Chin, MD University of Chicago Medical
Center
5
Key Design Features In the commercial setting…
6
Key Design Features In the safety-net setting…
7
Comparison of Research Questions
8
Comparison of Research Questions (continued)
9
Comparison of Measures In the commercial setting…
10
Measures In the safety-net setting…
11
Challenges/ Concerns
  • Complex interventions
  • Short time horizons
  • Small sample sizes
  • Randomization challenges
  • Standardizing measurement across pilot projects
  • High level of enthusiasm among payers and
    employers
  • Potentially underfinanced… more funding partners
    needed

E. Schneider, M. Rosenthal, Another Chasm to
Cross? Evaluating the PCMH, presentation at
AcademyHealth Annual Research meeting,
invitational breakout session (June 2008).
12
Considerations for Future Medical Home Evaluations
  • What will we learn thats new?
  • Need variation in demonstration design (e.g.,
    payment, TA)
  • Multi-payer strongly preferred
  • Standardization of metrics to enable
    cross-project comparisons
  • Keeping patients at the center without patient
    perspective, its not a patient-centered medical
    home
  • Co-funding
  • Must assure independence of investigator to
    publish results regardless of outcome
  • Robust design
  • Clarity about implications for key audiences
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