Care Coordination, Access Crucial to PCMH Success

Elements of the patient-centered medical home (PCMH) model most strongly linked with clinical quality are care coordination, access, continuity, and communication, according to a recent study in JAMA Internal Medicine.

The study looked at 48 quality indicators at 909 clinics in the Veterans Health Administration’s PCMH initiative, which is called the Patient Aligned Care Team (PACT) program. Researchers gauged each clinic’s progress in PCMH implementation in 2012 using the PACT implementation Progress Index (Pi2), which spans eight core components: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision-making, and team-based care.

“Overall, higher scores on each of the 8 components of Pi2 were associated with better performance on clinical quality indicators,” researchers wrote. “The Pi2 components that were most strongly associated with a clinic meeting the most clinical quality indicators were care coordination, access, continuity, and communication.”

Compared with clinics with lower scores, clinics with high scores in care coordination performed significantly better on 33 of the 48 quality indicators, the study found. Results were similar for access (high-performing clinics performed significantly better on 32 indicators), continuity (29), and communication (25).

When extrapolated to all 5.4 million primary care patients in the Veterans Health Administration system, results suggested that 310,468 additional high-quality care services could have been provided had all clinics performed similarly to high-quartile clinics for care coordination, according to the study. For access, nearly 258,999 additional services could have been delivered had all clinics performed at the highest-quartile level; for continuity, 253,816 additional services could have been delivered; according to the study results. —Jolynn Tumolo