Medical home model saves money, boosts quality, study finds

Cutting patient loads and making visits longer were also found to ease burnout rates for physicians.

By — Posted Sept. 14, 2009

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Implementing a patient-centered medical home in Bellevue, Wash., lowered physician burnout rates and improved patients' satisfaction with their care, according to an evaluation of a clinic that incorporated elements of the health care model.

The study, in the September American Journal of Managed Care, found that fewer physicians and other health care professionals who worked at the medical home -- 10% of the 35 surveyed -- reported feeling "burned out" or emotionally exhausted after a year. In contrast, 30% of the 47 staff members, including doctors, who worked in other clinics reported feeling burned out after a year.

In addition, patients in the medical home had 29% fewer emergency department visits than those in the control groups at other clinics. They also reported being more satisfied with care coordination and their interactions with physicians.

The study involved Group Health Cooperative, a Seattle-based nonprofit health care system founded in 1947. The cooperative incorporated medical home components at its 9,200-patient Factoria Medical Center, one of 26 centers in the system. The study was conducted from 2006 to 2007 as a pilot project.

Researchers at the cooperative's Group Health Center for Health Studies defined a medical home as a practice that provides expanded primary care, focuses on prevention and care coordination, and actively involves patients in health decisions.

Researchers found that the medical home model provided more time for office visits, more preventive care and improved collaboration among health care professionals. A care team meeting was held each morning to review the previous day's activities and plan for the day ahead.

"A medical home is like an old-style family doctor's office, but with a whole team of professionals," said lead author Robert J. Reid, MD, PhD, an associate investigator with the center.

Creating quality patient visits

In building its medical home, Group Health added staff to reduce the number of patients from an average of 2,327 per physician to 1,800. Patient visits were extended from 20 minutes to 30 minutes.

"Many primary care providers work so hard, they feel like they're on a hamster wheel," Dr. Reid said.

The physicians who worked in the medical home "had more time to sit and talk to the patient and to troubleshoot and solve problems," he said. "It's fair to say they didn't work any less but that they felt more capable in the work they were doing and felt it was more sustainable in the long term."

The changes cost $16 more per patient in extra staffing, which included more primary care physicians, physician assistants, registered nurses and pharmacists. Patients averaged $37 more in specialty care for the year, researchers said, perhaps because the enhanced primary care detected previously hidden health problems.

But the costs were recouped within the year. Less emergency department use led to savings of $54 per patient.

Impressed by the findings, Group Health is expanding the medical home model to all of its medical centers.

"These findings are important because they provide a 'proof of concept' that investments in a medical home can achieve relatively rapid returns across a range of key outcomes," Dr. Reid said.

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External links

"Patient-Centered Medical Home Demonstration: A Prospective, Quasi-Experimental, Before and After Evaluation," American Journal of Managed Care, published online Sept. 1 (link)

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