Patient-Centered Medical Home and Diabetes

The current model of health care delivery is designed to address acute health problems and is based on episodic face-to-face interactions between health care provider and patient, which often do not address the needs of chronically ill individuals (1). Diabetes is a well-documented example of a high cost prevalent chronic illness where a significant quality chasm exists. It is one of the most expensive chronic illnesses affecting over 23 million Americans (2) at a cost of 174 billion in 2007 (3). Despite the high expenditures for diabetes care, very few patients with diabetes are at goal for evidence based recommendations, with only 7% of patients at goal for A1C, blood pressure, and LDL cholesterol (4). In the recent years, much discussion has taken place regarding future health policies and the need to strengthen primary care. It is believed that improvements in the mode of delivery of primary care will better serve the needs of the chronically ill (5). Health outcomes are better in regions in which there is an adequate supply of primary care physicians, and patients receiving care from primary care physicians are healthier (6) and have fewer inpatient hospitalizations (7), fewer emergent admissions (8), a lower length of stay (8), and lower costs of care (9–11). The Patient-Centered Medical Home (PCMH) has been proposed as a practical solution to the primary care crisis and holds promise to deliver better chronic care. Diabetes lends itself well to the principles of the PCMH given its robust evidence-based guidelines, high cost, and well demonstrated quality gap. Although a common definition of the PCMH has remained elusive (12), the basic elements of a PCMH are well described by the Joint Principles of the American Academy of Family Medicine, American Academy of Pediatrics, American College of Physicians and the …