PATIENT-CENTERED MEDICAL HOMES AND DIABETES OUTCOMES: AN INTEGRATED LITERATURE REVIEW

Driven by the need to improve patient quality outcomes—while providing efficient and cost effective care—many healthcare systems have adopted the transformational model, patient centered medical home (PCMH), to managed patients with chronic diseases. This integrated literature review provides a critical appraisal of the evidence relating to diabetes care in PCMH settings, along with evidence syntheses. The review and syntheses are guided by the Agency for Healthcare Quality and Research (AHRQ) framework for PCMH. 96 studies were systematically retrieved from the relevant databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Cochrane Review, Academic Premier (EBSCO), and PsychINFO. Only empirical studies published in English between 2003 and 2014 were included. 84 studies were eliminated for not meeting the criteria, leaving 12 studies for further analysis. The findings suggest that current evidence on the efficacy of the PCMH model in diabetes mellitus (DM) outcomes is equivocal. Only five studies reported improved quality outcomes, four studies showed improved process outcomes, and the remaining three studies showed no improvement in either measure for DM care in the PCMH setting. Where there were successful implementations of the PCMH model, they were supported by dedicated workflows, a consistent approach to care delivery, and teams that are well-managed. The limitations of the review included findings that were not generalizable, heterogeneous study designs, lack of comparison groups and non- iv randomized comparison practices. Future studies need to consider longitudinal designs, in which the PCMH’s effect on diabetes outcomes can be observed over time.