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Invited Commentary
August 2014

Not All (Medical) Homes Are Built Alike: Some Work Better Than Others

Author Affiliations
  • 1American Board of Internal Medicine, Philadelphia, Pennsylvania
JAMA Intern Med. 2014;174(8):1358-1359. doi:10.1001/jamainternmed.2014.2497

In this issue of JAMA Internal Medicine, Nelson et al1 provide an informative study of a large-scale implementation of the patient-centered medical home (PCMH) model within the Veteran’s Health Administration (VHA), looking at important outcomes of hospitalization and emergency department use, patient satisfaction, and staff burnout. The scale of the study is impressive, involving administrative and clinical data on 5.6 million veterans receiving care at all 913 VHA clinics. The findings that both utilization rates and staff burnout declined while patient satisfaction improved have face validity and will encourage continued development of this model. Perhaps even more important, the authors confront head on some of the methodologic challenges in studying PCMH implementation, including the variable definitions of the PCMH model itself, the need to risk-adjust for the varying populations that might be served, and factors other than the implementation of the PCMH that could be contributing to any observed variation. Even though the study was done within the VHA—which might lead some readers to question the relevance of the findings to outside systems—the design of the study allows us to glean some highly relevant national lessons.

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