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Invited Commentary
Health Policy
February 5, 2020

The Patient-Centered Medical Home and the Challenge of Evaluating Complex Interventions

Author Affiliations
  • 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Center for Primary Care, Harvard Medical School, Boston, Massachusetts
  • 3Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
  • 4Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
JAMA Netw Open. 2020;3(2):e1920827. doi:10.1001/jamanetworkopen.2019.20827

The study by Reddy and colleagues1 reports on an analysis of the Patient Aligned Care Team (PACT) initiative, a patient-centered medical home (PCMH) initiative from the US Department of Veterans Affairs (VA) and one of the largest PCMH initiatives in the country. Involving more than 1 million patients during 4 years (2012-2015), the study tapped into the extensive databases of the VA, including results from surveys of patients and staff specifically designed to capture elements of PCMH. Reddy et al1 examined the association of longitudinal changes in PCMH implementation with 3 high-cost health care utilization outcomes: emergency department (ED) visits, hospitalizations for ambulatory care–sensitive conditions (ACSCs), and all-cause hospitalizations. They found no consistent association of more robust PCMH implementation with better outcomes.

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