A Meta-analysis of Patient Centered Medical Home Initiatives
Data Sources: Pooled results from 11 meta-analysis pilot evaluations.
Study Design: We performed a meta-analysis on the results from different PCMH pilots aimed at impacting 13 quality, cost, and utilization outcomes. All pilots included financial incentives for improvement, and at least two years of pre and post data. Each site performed difference-in-difference analyses whose results were pooled in a random effects meta-analysis model. A subgroup of higher morbidity patients was also evaluated.
Data Collection Methods: In order to reduce analytical bias, each site re-ran their initial analysis to a common set of specifications before pooling into the meta-analysis.
Principal Findings: We found a significant pooled increase of cervical cancer screenings of 0.49 screenings per 1,000 patient months (p=0.001), representing a 0.86% change from the baseline with no evidence of heterogeneity (p=0.912). In the higher morbidity sample, there was a significant pooled increase of 0.64 breast cancer screenings per 1,000 patient months, representing a 0.97% increase from baseline with no evidence of heterogeneity (p=0.191). There was also a pooled significant reduction of costs by $9,000 per 1,000 patient months (p=0.05), a 2.8% reduction from baseline, however with some potential heterogeneity (p=0.005). No other outcomes yielded significant results.
Conclusions: Across multiple studies, PCMHs can yield modest results on quality and cost measures, in particular among a higher morbidity patient population. More research is needed to identify which specific components of different PCMH interventions may contribute the most to success.