Medical Home Culture, EHR Use Linked to Better Care
Physicians practicing in a patient-centered medical home with an electronic health records system provide more recommended care than counterparts not in a medical home and using paper or electronic records.
That is the conclusion of a study published in the Annals of Internal Medicine which finds that PCMH practices performed 6 percent better than non-PCMH practices with an EHR and 7 percent better than the paper-based non-PCMH practices in adhering to 10 quality measures. The PCMH practices improved adherence with recommended care protocols over time, while the other practices did not.
Results from the study suggest that the PCMH practices have an advantage beyond use of the EHR; that changes to organizational culture seem to play a role, study authors conclude. This includes developing a culture of supporting population health management, building a team by defining roles and responsibilities, and becoming accountable for performance, they add. None of these focus on information technology but at least 2 (population management and accountability for performance) are substantially enabled by EHRs. Of note, we did not have a PCMH group that did not use EHRs because that combination of interventions did not exist. Thus, instead of reflecting the incremental value of the PCMH beyond that of the EHR, our results suggest the combined effect of the EHR with the organizational changes of the PCMH.
Researchers at Weill Cornell Medical College in New York City conducted the study, which took place in the seven-county Hudson Valley region north of the city. Of the 675 participating primary care physicians, 190 were in the PCMH group, 367 were in the paper group and 118 were in the EHR group. Together, the practices served 143,489 patients during the three-year study period.
The study used data from six insurers serving the region and from Taconic Health Information Network and Community (THINC), which offers health information technology and data exchange services and is a partner of Taconic IPA, a large independent practice association in the region. Data from 2008, 2009 and 2010 was used in the study. This period predates the HITECH Act, which substantially accelerated use of EHRs and other information technologies in the years after the EHR meaningful use program started in 2011.
Now, researchers want to go further and move into the meaningful use era by analyzing data from 2011 and 2012, which may be able to address the impact of Stage 1 in improving adherence to recommended care, says Susan Stuard, executive director of THINC.
The study is available here for $29.95.