The Patient-centered Medical Home as an Intervention Strategy for Diabetes Mellitus: A Systematic Review of the Literature

Abstract

Background: Poorly managed diabetes mellitus increases health care expenditures and negatively impact health outcomes. There are 34 million people living with diabetes in the United States with a direct annual medical cost of $237 billion. The patient-centered medical home (PCMH) was introduced to transform primary care by offering teambased care that is accessible, coordinated, and comprehensive. Although the PCMH is believed to address multiple gaps in delivering care to people living with chronic diseases, the research has not yet reported clear benefits for managing diabetes. Objective: To review the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understand the impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and health related outcomes. Method: The systematic review was performed according to the Cochrane method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight databases were systematically searched for articles. The Oxford Centre for Evidence-based Medicine levels of evidence and the Critical Appraisal Skills Programme systematic review checklist were used to evaluate the studies. Results: The search resulted in 596 articles, of which 24 met all the inclusion criteria. Care management resulted in more screenings and better preventive care. Pharmacy-led interventions and technology were associated with positive clinical outcomes, decreased utilization, and cost savings. Most studies reported decreased emergency room visits and less inpatient admissions. Conclusion : The quality and strength of the outcomes were largely inconclusive about the overall effectiveness of the PCMH. Defining and comparing concepts across studies was difficult as universal definitions specific to the PCMH were not often applied. More research is needed to unpack the care model of the PCMH to further understand how the individual key components, such as care bundles, contribute to improved outcomes. Further evaluations are needed for team-based care, communication, and care coordination with comparisons to patient, clinical, health, and financial outcomes.

Effectiveness of care models for chronic disease management: A scoping review of systematic reviews

“…Of 4108 articles undergoing title and abstract screening, 389 underwent full‐text review to determine eligibility (Figure 1). A total of 186 systematic reviews were deemed eligible for the scoping review 18–203 . Details of each review are summarized in Table…”

Evaluation of an interprofessional primary healthcare team as a new model of primary care in Quebec: a protocol for a type 2 effectiveness-implementation hybrid study

“…Access to this interprofessional approach is also facilitated because no fee is charged. In addition, compared with other reported primary care models,38 43 44 there is no preselection of patients, with all patients being eligible for the appropriate professional services. Our research project seeks to understand the experience of users attending a clinic based on this model to assess the relevance of this model for this population.…”

¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi

“…Una atención médica centrada en la persona puede arrojar múltiples beneficios y diversos estudios ya han demostrado su eficacia. Programas de ACP han conseguido mejorar el control y reducir complicaciones en diabetes 20 , 21 , e incluso adaptar las metas del tratamiento a las características individuales de la persona y su entorno 22 . Esta mejoría en el control aplicando ACP también es aplicable a otras enfermedades crónicas como el síndrome depresivo, la hipertensión arterial o la hipercolesterolemia 23 .…”