Monday, February 16, 2009

Advocates of "Medical Homes" find little cheer in coordinated care study

A recently published study of 15 coordinated care programs found little evidence of benefit,no cost saving and no change in various "adherence" measures. A detailed discussion of the JAMA article can be found here at Junkfood Science.The JAMA article can be found here.

The notion that if we could educate patients better and interact with them more closely to encourage adherence to recommended care then costs would fall and quality of care would increase has been advocated by several professional organizations and policy wonks and disease management companies. The Balanced Budget Act of 1997 mandated that the Secretary of HHS study coordination of care programs in the Medicare setting. The JAMA article is the result of one such large study. Coordination of care is a major element in the Medical Home concept.Basically these coordinated care programs consisted mainly of educational activities by nurses and monitoring (usually by telephone calls) of patient adherence to medical care recommendations.

The negative results here remind me of a earlier publication investigating the similar results of a disease management program that I discussed several years ago.

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