Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes

Abstract

Abstract. Understanding patient experience is necessary to advance the patient-centred approach to health service delivery. Australia's primary healthcare model, the 'Health Care Home', is based on the 'Patient-Centered Medical Home' (PCMH) model developed in the United States. Both these models aim to improve patient experience; however, the majority of existing PCMH model evaluations have focussed on funding, management and quality assurance measures. This review investigated the scope of evidence reported by adult patients using a PCMH. Using a systematic framework, the review identified 39 studies, sourced from 33 individual datasets, which used both quantitative and qualitative approaches. Patient experience was reported for model attributes, including the patient-physician and patient-practice relationships; carecoordination; access to care; and, patient engagement, goal setting and shared decision-making. Results were mixed, with the patient experience improving under the PCMH model for some attributes, and some studies indicating no difference in patient experience following PCMH implementation. The scope and quality of existing evidence does not demonstrate improvement in adult patient experience when using the PCMH. Better measures to evaluate patient experience in the Australian Health Care Home model are required.Additional keywords: healthcare evaluation, health services research, quality of health care.

Health Care Homes and whole-person care: A qualitative study of general practitioners’ views

“…Participants identified HCHs' potential to encourage continuity of care, a view supported by evidence from Patient-Centred Medical Home (PCMH) implementation in the USA. [12][13][14] While patients believe continuity improves the doctor-patient relationship, 15,16 the participants identified that building relationships requires time, which may be compromised by funding shifting care delivery away from the GP. Some GPs anticipated benefit from patients developing relationships with other care providers, provided there was effective communication among a GP-led team.…”

“…Evidence regarding PCMH patients' experience in relation to patient-provider and patient-practice relationships in the USA is mixed, and this issue deserves further consideration. 14 The participants reported practical struggles associated with HCH implementation. Previous literature anticipated difficulties concerning the transformation process, electronic health records, funding, and practice structure and resources.…”

Corrigendum to: Preventable hospitalisations in regional Queensland: potential for primary health?

“…Evidence from implementation studies of the Medical Home in the US has demonstrated some improvement in preventative care service delivery for people with chronic conditions, although results are mixed and insufficient for service provision (including accessibility and coordination of care), clinical outcomes, in-patient utilisation 41 and patient experience. 42 Diversity in the primary care setting has challenged implementation of the Medical Home care model, indicating a need for setting-specific approaches to address the healthcare needs of distinctive population subgroups.…”

Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

“…The time and resources required to implement the model and to transform work processes incur substantial costs, both one-time and ongoing (5,15,16). Studies that examine patient experiences of PCMH have been mainly limited to patient-provider relationship and access to care, whereas other aspects such as patient engagement, activation, shared decision-making and patient experience with other practice staff have received less investigation (17).…”