A recent JAMA study questions the current value of the “patient-centered medical home” (PCMH). PCMH organizations seek to proactively improve healthcare outcomes among the chronically ill by coordinating care within one provider group. PCMHs typically emphasize outreach to patients for closer management and monitoring of their illnesses. Unlike earlier, smaller studies, the most recent report by Mark Feinberg and co-authors does not find improved outcomes on 10 of 11 measures for patients with chronic illnesses. Also, among 64,000 patients enrolled in 32 primary care practices in Pennsylvania, hospitalizations, ER visits, and costs were not reduced over a three-year period.
The PCMH model is seen as a key to reforming healthcare delivery. The Veteran’s Administration began converting its primary care delivery to a PCMH model in 2010, and many other healthcare systems are also experimenting with PCMHs. The study authors and JAMA editorial board agree that the PCMH model is still in development. Its success will depend on evidence-based adjustments to PCMH structures and practices.
Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care. JAMA. 2014;311(8):815-825. doi:10.1001/jama.2014.353.
Schwenk TL. The Patient-Centered Medical Home: One Size Does Not Fit All. JAMA. 2014;311(8):802-803. doi:10.1001/jama.2014.352.
How can physicians strike an ethical balance between patient care and cost containment? Should this be a concern of physicians at all? The American Society of Clinical Oncology is calling on its members to be “stewards of the larger society” by considering the cost of treatment, along with its efficacy and medical appropriateness. Other medical societies and physician groups are also moving toward crafting guidelines on cost of care. Entering this ethical minefield seems unavoidable for physicians as cost containment continues to be a prime concern for patients, payers and policymakers.
In an alarming side bar to the recent measles outbreak in New York City, the New York Times reported that the virus may have been spread when healthcare workers failed to recognize the illness as measles. As a result, patients were not quarantined and more cases may have resulted. Quoted in the article, Columbia University Medical Center administrators noted that, “Many of our clinical staff have never seen a case of measles.” Children too young to be vaccinated, children missing vaccinations, and adults have all been infected in this outbreak. Outbreaks like these, although rare, highlight the importance of vaccination in protecting the entire community from preventable infectious disease.