More Time May Be Needed
"It turns out that taking the patient-centered medical home concept out into the real world is a whole 'nother kettle of fish," says Mark Friedberg, MD, a RAND Corporation scientist and practicing internist at Brigham and Women's Hospital. Friedberg is the study's lead author.
"When you take a system [primary care] that's already under stress and potentially apply even more stress by asking it to transform, it may not be able to respond as you hope, especially over the short time period that most pilot projects run, and this one ran much longer, three years."
He adds that results from this and several other trials show that changing physicians' behavior to do more for their patients outside the office, with reminders and communication and follow-up, "is just really hard to do. And we're now concerned that medical home transformations may not really achieve the goals set out for them at the rapid pace that people have hoped."
It may, in fact, take a lot longer than three years, he says.
In an accompanying editorial, Thomas Schwenk, MD, of the University of Nevada School of Medicine in Reno and Las Vegas, wrote that the PCMH model has been held up as "the foundation for all primary care delivery, including the solo and small group practices that dominate the primary care delivery system."