Abstract
High-Cost Health Care Utilization and Longitudinal Changes in Patient-Centered Medical Home Implementation
Highlights
While there has been considerable enthusiasm about the potential for patient-centered medical home (PCMH) to revolutionize primary care in the United States, PCMH is more of a collection of core principles than a set of specific interventions
The complexity of the intervention being attempted in the Veterans Affairs (VA) PCMH initiative is evidenced by the main measure for its implementation, the Patient Aligned Care Team (PACT) implementation progress index (Pi2) score
Given that a basic principle of scientific investigation is to control as many variables as possible, ideally isolating a single independent variable to study its effect or associations, it should not be surprising that the findings of system-level studies that include multiple independent variables and multiple outcomes of PCMH interventions have included mixed results
Summary
While there has been considerable enthusiasm about the potential for PCMH to revolutionize primary care in the United States, PCMH is more of a collection of core principles than a set of specific interventions. It is possible that out of the many elements of PACT, those that can reduce ED visits or hospitalizations were not effectively implemented or were implemented to a similar degree in the 2 periods studied.
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