RESUMO
OBJECTIVES: To systematically review the current evidence on the patient-centered medical home (PCMH, or medical home), which aims to reinvigorate primary care and achieve the triple aim of better quality, improved experience, and lower costs. STUDY DESIGN: Systematic review of quantitative evidence on the PCMH. METHODS: Out of 498 studies published or disseminated from January 2000 to September 2010 on US-based interventions, 14 evaluations of 12 interventions met our inclusion criteria: (1) tested a practice-level intervention with 3 or more of 5 key PCMH components and (2) conducted a quantitative study of one of the triple aim outcomes or of healthcare professional experience. We synthesized findings on interventions that were evaluated using rigorous methods. We also provide guidance to structure future evaluations to maximize learning. RESULTS: The interventions most often cited to support the medical home can be viewed as precursors to the medical home. Evaluations of 6 of these interventions provided rigorous evidence on 1 or more outcomes. This evidence indicates some favorable effects on all 3 triple aim outcomes, a few unfavorable effects on costs, and many inconclusive results. CONCLUSIONS: Although the PCMH is a promising innovation, rigorous quantitative evaluations and comprehensive implementation analyses are needed to assess effectiveness and refine the model to meet stakeholders' needs. Findings from future evaluations will help guide the substantial efforts practices and payers invest to adopt the PCMH with the goal of achieving the triple aim outcomes.
