Title:The Patient-centered Medical Home as an Intervention Strategy for Diabetes Mellitus: A Systematic Review of the Literature
Volume: 17
Issue: 3
Author(s): Lisa S. McManus, Karen A. Dominguez-Cancino, Michele K. Stanek, Juan. M. Leyva-Moral, Carola E. Bravo-Tare, Oriana Rivera-Lozada and Patrick A. Palmieri*
Affiliation:
- College of Nursing, Walden University, Minneapolis,United States
Keywords:
Patient-centered medical home, diabetes, teamwork, care coordination, multidisciplinary, communication.
Abstract: Background: Poorly managed diabetes mellitus increases health care expenditures and
negatively impacts 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 team-based 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: The study reviews the scientific literature about diabetes mellitus outcomes reported by
PCMHs, and understands the impact of team-based care, interdisciplinary communication, and care
coordination strategies on the clinical, financial, and health-related outcomes.
Methods: 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.
