Commonwealth Fund recommends core PCMH evaluation measures
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The New York City-headquartered organization described the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate the patient centered medical home focusing on two domains of medical home outcomes: cost/utilization and clinical quality.
“There are numerous initiatives across the country testing the promise of the medical home model. More than 90 commercial health plans, 42 states and three federal initiatives are participating in such tests, with thousands of providers who serve millions of patients,” the brief dated. “However, only a few evaluations have been published on the impact of the PCMH model as a whole, although elements have been shown to be associated with higher quality and lower cost. With rigorous, comparable data, payors, providers and patients will be better positioned to understand results, improve the model, strengthen primary care, achieve high performance and experience better health outcomes.”
The clinical quality work group assembled a proposed set of standardized, validated technical quality measures relevant to the patient-centered medical home concept. These included existing Ambulatory Care Quality Alliance recommendations, as well as the Healthcare Effectiveness Data and Information Set measure set, the Physician Quality Reporting Initiative measures and other state and payor demonstration measures.
“To a large degree, the recommended technical quality and patient experience measures overlap with recently released accountable care organization (ACO) final rule quality measures,” the brief stated. “To be interpretable, researchers should apply a validated approach to data collection. This is particularly important if measures are collected from the medical record or EHR. In addition, evaluators should use consistent measures across practices within a pilot or demonstration.”
Finding the appropriate mix of process and outcome measures needs to be further considered, the report warned. “Given the focus on managing the health of a defined population, intermediate outcome measures—often of chronic disease—might be preferred over process measures. However, given concerns about the ability of PCMH pilots to demonstrate large outcome changes over short time periods, the work group also emphasized key process measures as well.”
The researchers concluded the measures might be more affected over a short time period, and also have the advantage of often having lower variance.
To view the standardized measures, visit the Commonwealth Fund’s website.