A new policy brief from The Commonwealth Fund describes recommendations of more than 75 researchers who identified a core set of standardized measures to evaluate the patient-centered medical home (PCMH). The brief focuses on 2 domains of medical home outcomes—clinical quality and cost/utilization.
The researchers broadly agreed about the importance of assessing changes in clinical quality as part of any medical home program. They expressed concerns that the variation in populations and local PCMH emphasis might make uniform minimum quality measure sets difficult to generalize. Therefore, they agreed to a core set of principles that all evaluators should follow when examining clinical quality. In particular, they call for select measures from each of the following core areas of primary care measurement—preventive care, chronic disease management, acute care, overuse, and safety.
The majority of researchers recommend including emergency department visits, hospitalizations, and readmissions as the primary utilization indicators in the minimum measure set. According to the group's analysis, these indicators were both consistent with the logic model that attempted to capture how a medical home could affect utilization, cost, and efficiency and were supported by at least some empirical evidence.
For cost measures, there was consensus that evaluations of PCMHs should always include analysis of total per-member per-month cost effects for high-risk patients, since the PCMH initiative will most likely be able to detect a measureable effect on this patient population.
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