Establishing Federal Resources to Support Patient-Centered Medical Home Concept

Proponents of the Patient-Centered Medical Home (PCMH) model expected it to transform primary care by improving the health of populations and decreasing costs. This project developed a conceptual framework and communications infrastructure to serve as a base for the Agency for Healthcare Research and Quality (AHRQ) and others in the Federal government to conduct research and develop recommendations for the further development and implementation of this model of care.

The main objectives of the project were to:

• Monitor emerging efforts and knowledge using an environmental scan, leading to effective synthesis of the knowledge and issues emerging in primary care and other health policies that may affect PCMH to help policymakers understand emerging PCMH initiatives.
• Make substantive contributions to fill gaps through the development of white papers on PCMH-related topics.
• Provide administrative support for work by AHRQ and the Federal Government to identify Federal activities relevant to medical homes and how they relate to each other and emerging private sector initiatives, facilitated by convening the Federal Collaborative for the Patient Centered Medical Home.
• Develop a strategic plan that identifies how AHRQ can contribute to developing public and private sector work to improve primary care delivery.

In order to meet these objectives, the project team undertook several activities. These are described below:

Medical Home Definition:A definition of the medical home was created in close collaboration with AHRQ as a model of the organization of primary care that delivers the core functions of primary health care. The medical home encompasses five functions and attributes, including being patient-centered, providing comprehensive care, providing coordinated care, providing superb access to care, and having a systems-based approach to quality and safety.

Environmental Scan:The project team completed a comprehensive literature review and environmental scan. In addition, they reviewed nearly 100 Web sites for content related to the medical home. From this work they created and updated a comprehensive searchable database containing more than 780 citations for resources on the medical home. These resources include journal articles, reports, policy briefs, selected newsletters and trade publications, and position statements.

White Papers:With input from expert panels, decision makers, researchers, practitioners, and advocates, the team developed a series of white papers. These included: Engaging Patients and Families in the Medical Home; Integrating Mental Health and Substance Use Treatment in the Patient-Centered Medical Home; Necessary, But Not Sufficient: The HITECH Act's Potential to Build Medical Homes; Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms; and The Medical Home: What Do We Know, What Do We Need to Know? A Review of the Current State of the Evidence on the Effects of the Patient-Centered Medical Home Model.

Decisionmaker Briefs:Several short briefs were developed that summarized selected white papers for easy dissemination.

Evidence Reviews:Eighteen evidence reviews of 16 models of the medical home were completed. Each summary contains four sections that address these questions: what was evaluated, how it was evaluated, if the model worked, and what is on the horizon.

Federal PCMH Collaborative:The project team helped to develop the Federal PCMH Collaborative steering committee, with 172 members representing 14 agencies and departments. The committee advised AHRQ on meeting topics, knowledge gaps on the PCMH, and how the Collaborative could meet the needs of members. In addition, the team developed content for the Federal PCMH portal, which is accessible only to members of the Collaborative.

Each of these activities filled gaps in the conceptualization and understanding of key components of the medical home model. In summary, the project team made substantial contributions to the PCMH knowledge base and a solid foundation for continued work in the field. The PCMH model is expected to transform primary care by improving the health of populations and decreasing costs.