Trial reportJournal of general internal medicine2013
A randomized, controlled trial of implementing the patient-centered medical home model in solo and small practices.
Trial report in Journal of general internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effectiveness of Intensive Primary Care Interventions: A Systematic Review.Journal of general internal medicine · 2017Pooled it
- An Approach to Assess Generalizability in Comparative Effectiveness Research: A Case Study of the Whole Systems Demonstrator Cluster Randomized Trial Comparing Telehealth with Usual Care for Patients with Chronic Health Conditions.Medical decision making : an international journal of the Society for Medical Decision Making · 2015Trial
- Quality and efficiency in small practices transitioning to patient centered medical homes: a randomized trial.Journal of general internal medicine · 2013Trial
- Practice facilitation to improve diabetes care in primary care: a report from the EPIC randomized clinical trial.Annals of family medicineTrial
- Using a theoretical framework to inform implementation of the patient-centred medical home (PCMH) model in primary care: protocol for a mixed-methods systematic review.Systematic reviews · 2022Article
- Mental health care integration and primary care patient experience in the Veterans Health Administration.Healthcare (Amsterdam, Netherlands) · 2021Article
- Association between service scope of primary care facilities and patient outcomes: a retrospective study in rural Guizhou, China.BMC health services research · 2021Article
- Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot.Journal of general internal medicine · 2016Article
- Categories of Practice Transformation in a Statewide Medical Home Pilot and their Association with Medical Home Recognition.Journal of general internal medicine · 2015Article
- "I have a hunch".American health & drug benefits · 2014Article
- General internal medicine as an engine of innovation.Journal of general internal medicine · 2013Article
- Moving ahead with the PCMH: some progress, but more testing needed.Journal of general internal medicine · 2013Article
- Costs of Transforming Established Primary Care Practices to Patient-Centered Medical Homes (PCMHs).Journal of the American Board of Family Medicine : JABFMArticle
Corrections and comments
- Commented on by
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTransition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices.
objectiveTo test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2-10 providers) primary care practices over 2 years.
designRandomized Controlled Trial.
participantsEighteen supported practices (intervention) and 14 control practices (controls).
interventionsIntervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance's (NCQA) Physician Practice Connections(®)-Patient-Centered Medical Home™ (PPC(®)-PCMH™) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC(®)-PCMH™. MAIN MEASURES: PPC(®)-PCMH™ at baseline and 18 months, plus intervention at 7 months. KEY
resultsAt 18 months, 5 % of intervention practices and 79% of control practices were not recognized by NCQA; 10% of intervention practices and 7% of controls achieved PPC(®)-PCMH™ Level 1; 5% of intervention practices and 0% of controls achieved PPC(®)-PCMH™ Level 2; and 80% of intervention practices and 14% of controls achieved PPC(®)-PCMH™ Level 3. Intervention practices were 27 times more likely to improve PPC(®)-PCMH™ by one level, irrespective of practice size (p < 0.001) 95% CI (5-157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect (p(time7) = 0.01), which was twice as large as the sustained effect over subsequent 12 months (p(time18) = 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC(®)-PCMH™ standards over time (p(time x group)=0.03). Intervention practices improved eight of nine standards, controls improved three of nine (p(PPC1) = 0.009; p(PPC2) = 0.005; p(PPC3) = 0.007).
conclusionsIrrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.