PURPOSE Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services.
METHODSWe undertook cross-sectional analyses using baseline patient and practice member surveys and chart audits from a quality improvement trial in 24 primary care offi ces. Association of PCMH principles with preventive services (receipt of cancer screening, lipid screening, infl uenza vaccination, and behavioral counseling) was examined using hierarchical linear modeling.
RESULTSHigher global PCMH scores were associated with receipt of preventive services (β = 2.3; P <.001). Positive associations were found with principles of personal physician (β = 3.7; P <.001), in particular, continuity with the same physician (β = 4.4; P = .002) and number of visits within 2 years (15% higher for patients with 13 or more visits; P <.001); and whole-person orientation (β = 5.6; P <.001), particularly, having a well-visit within 5 years (β = 12.3; P <.001) and being treated for chronic diseases (6% higher if more than 3 chronic diseases; P = .002). Having referral systems to link patients to community programs for preventive counseling (β = 8.0; P <.001) and use of clinical decision-support tools (β = 5.0; P = .04) were also associated with receipt of preventive services.CONCLUSIONS Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes. Ann Fam Med 2010;8:108-116. doi10.1370/afm.1080
INTRODUCTIONT he patient-centered medical home (PCMH) is being promoted as the future of primary care practice that will help reform the US health care system into one that is more accessible, effective, effi cient, safe, and economical. 1 The PCMH includes several principles: (1) an ongoing relationship with a personal physician for fi rst-contact, continuous, and comprehensive care; (2) a physician-directed team that collectively cares for the patient; (3) whole-person orientation, including acute, chronic, preventive, and end-of-life care; (4) coordinated care across all elements of the health care system and the patient's community; (5) quality and safety through evidence-based medicine and clinical decision-support tools, information technology, registries, and continuous quality improvement; (6) enhanced access, achieved through such systems as open scheduling, expanded hours, and new options for communication between patients, their physician, and practice staff; and (7) payment reform to refl ect the added value that a PCMH provides to patients. The evidence showing effectiveness of high-tech information technology in improving quality o...