Pilot PCMH study reports improved outcomes without workflow disruptions

Time and cost won’t necessarily prevent your practice from becoming a patient-centered medical home (PCMH).

In a new study, a PCMH pilot was implemented in a busy, urban primary care practice and resulted in improved patient outcomes without workflow disruptions. The PCMH pilot was well-received by both providers and patients in the practice, and patients involved in the pilot program experienced increased life expectancy (12 months versus 6.7 months for those in the control group) and improvements in smoking cessation efforts.

The American Journal of Managed Care published the results of the pilot study in December 2014.

“Although preventable morbidity and mortality in the United States is substantive, evidence-based preventive care is underutilized,” according to the study’s authors. “It is increasingly appreciated that while primary care should become more personalized and patient-centered, time constraints may oppose these goals.”

The pilot program focused on identifying patients who would benefit most from improvements in preventive care, personalizing results and communicating information in a way that the patient can understand, sharing decision-making with the patient, and designating realistic steps toward reaching patient goals. Patients in the program were typically in their mid-50s and had healthcare goals such as reducing obesity and hypertension, diabetes and lipid control, and smoking cessation.

According to the study, the response to the program was positive, with only 2 out of 12 primary care physicians opting out of participation due to a concern over loss of autonomy over the management of their patients’ cases. Workflow issues were minimal and patients exhibited pride in regard to their charts and folders.

“Motivational interviewing and shared decision-making were well received, with those patients motivated to take the most responsibility for their own care making the greatest improvements,” the report states, citing the example of a woman with borderline diabetes and non-alcoholic fatty liver disease. After participating in the program, the woman is now enthusiastic about the plan she helped create with her physician and has lost 32 pounds and gained control over her hyperlipidemia, adding an estimated four years and three months to her life expectancy.

The study’s authors say the program was beneficial and not difficult to implement, despite fears over the length of time office visits in the PCMH would require.

“Our program not only provides personalized information, but patient-centers the decision making to promote active participation in setting and prioritizing health goals,” the study states. “Prior to program initiation, many clinicians and health policy experts warned us that it would be infeasible to construct a program requiring 40- to 60-minute office visits. We have demonstrated that these predictions were incorrect. Furthermore, we note that the same activities could be accomplished more cost-effectively through additional task shifting.”

The study notes that clinic staff can obtain vital signs and conduct routine interviewing, while another team member can resolve appointment and logistical issues, resulting in a 60-minute visit divided between four or five different roles within the clinic.

“Also of note, any program that achieves and sustains a life expectancy increase of 5.3 months would offer favorable value if its additional expenditures (including downstream costs) are lower than $44,000 per patient per year, which appears to greatly exceed the costs of our program,” the authors write.