Association between the patient-centered medical home and healthcare utilization

The patient-centered medical home (PCMH) model of primary care is being implemented widely, with unclear effects on healthcare utilization. How much any effect is driven by electronic health records (EHRs), a core component of PCMHs, is unknown. Our objective was to determine any association between the PCMH model and healthcare utilization and to isolate that effect from any by the EHR alone.

We conducted a prospective cohort study (2008-2010) of 275 primary care physicians and 230,593 patients in the Hudson Valley, a multi-payer region in New York state with predominantly small practices.

We considered 3 groups: physicians who implemented Level III PCMHs in 2009, as per the National Committee for Quality Assurance, all of whom also used EHRs (n = 92); physicians using paper medical records (n = 119); and physicians using EHRs without the PCMH (n = 64). We used negative binomial regression to determine associations between study group and change over time for each of 7 utilization measures, adjusting for 10 physician characteristics.

For every 100 patients whose physicians transformed to PCMHs, there were 21 fewer specialist visits over time compared with patients whose physicians used paper records (P = .03), and 22 fewer specialist visits over time compared with patients whose physicians used EHRs without the PCMH (P = .05). There were no significant differences over time in primary care visits, radiology tests, laboratory tests, emergency department visits, admissions, or readmissions.

The PCMH was associated with a significant decrease in the rate of specialist visits, the most expensive type of ambulatory visit, 1 year after PCMH implementation.