Background:
Poorly managed diabetes mellitus increases health care expenditures and negatively impact
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 teambased 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:
To review the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understand the
impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and
health related outcomes.
Method:
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.
Community-Based Participatory Research in Action: The Patient-Centered Medical Home and Neighborhood
