A new national study of small and medium-size physician practices shows that this group is not using many of the organized care processes of the patient-centered medical home model of health system reform included in the Affordable Care Act of 2010. The study by Diane Rittenhouse of the University of California-San Francisco and coauthors was published online June 30 by Health Affairs and will also appear in the journal’s August issue. It marks the first the first time national data has been collected to measure how doctors in practices with less than 20 physicians have incorporated the principles of the patient-centered medical home model. The importance of the study’s findings is underscored by the fact that 88 percent of all practices in the United States have nine or fewer physicians.
The authors used data from the National Study of Small and Medium-Sized Physician Practices, conducted between July 2007 and March 2009. They analyzed 1,344 of the 1,765 survey responses, excluding practices where fewer than 33 percent of the providers were primary care physicians. The four medical home principles they looked at were team-based care; coordinated care facilitated by electronic health records; a focus on quality and safety; and expanding patient access to care. On a scale created by the authors, practices on average earned 21.7 percent of the possible points for use of medical home processes, and solo and two-physician practices scored significantly lower. However, in the smaller practices physicians were significantly more likely to communicate with patients via e-mail and incorporate patient feedback into their practices.
“It appears that major changes will be required if the patient-centered medical home is to be widely adopted,” Rittenhouse and her colleagues conclude. Since small practices continue to play a major role in US health care delivery, the authors urge “health care leaders to identify and test potential strategies to accelerate reforms in these settings.”
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