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Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
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Related Experiment Video

Updated: Jun 25, 2025

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Tools to Gauge Progress During Patient-Centered Medical Home Transformation.

Denise D Quigley1, Zachary S Predmore1, Ron D Hays1

  • 1RAND Corporation (DDQ), Santa Monica, CA; RAND Corporation (ZSP), Boston, MA; Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (RDH), Los Angeles, CA.

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|May 24, 2024
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Summary

This review evaluated tools for patient-centered medical home (PCMH) implementation, finding PCMH-A and MHCCS-H actionable for quality improvement with light administrative burden. Further research is needed to link tools to improved quality outcomes.

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Area of Science:

  • Health Services Research
  • Quality Improvement Science
  • Primary Care Transformation

Background:

  • The Patient-Centered Medical Home (PCMH) model aims to improve primary care delivery.
  • Effective tools are needed to guide and assess PCMH implementation and practice transformation.
  • Evaluating existing tools is crucial for optimizing quality improvement efforts.

Purpose of the Study:

  • To review and evaluate tools designed for assessing and enhancing Patient-Centered Medical Home (PCMH) implementation.
  • To identify tools that support quality improvement during the PCMH change process.

Main Methods:

  • Conducted a literature search to identify publicly available PCMH survey tools.
  • Reviewed content of 5 PCMH tools for coverage of PCMH standards and requirements.
  • Assessed tools for their utility in evaluation and quality improvement.

Main Results:

  • Three tools—PCMH-A, PCAT-FE, and MHCCS-H—were identified as actionable for quality improvement.
  • PCMH-A covers the broadest range of practice capabilities and National Committee for Quality Assurance (NCQA) standards.
  • MHCCS-H uniquely addresses comprehensiveness of care, while PCMH-A and MHCCS-H offer light administrative burden and actionable improvement steps.

Conclusions:

  • Limited evidence currently links specific PCMH tools to improved quality outcomes due to few longitudinal studies.
  • PCMH-A and MHCCS-H are practical for quality improvement, though each has content gaps (e.g., comprehensiveness, access to care).
  • Further research is necessary to determine which PCMH evaluation tools are most effective in driving quality improvements.