Medical homes that provide both primary and specialty care with multiple features to promote prompt effective care are potentially the most cost-effective for high-risk patients, particularly high-risk children with chronic illness whose care is often fragmented, costly, and ineffective, according to scientists at University of Texas Medical School, Houston. These medical homes had an increase in access to care and parent satisfaction and a reduction in serious illnesses.
Although a patient-centered or family-centered medical home is widely recommended these days, its value in improving clinical outcomes or reducing health care costs remains to be demonstrated.
Researchers randomly assigned 201 high-risk children with chronic illness to receive comprehensive care or usual care. Comprehensive care when compared to usual care reduced the number of children with a serious illness by 55 percent and total hospital and clinic costs from $16,523 vs. $26,781 per child-year respectively. The costs were also reduced for emergency department visits, hospitalizations, number of days in the hospital, intensive care unit (ICU) admissions and days in the ICU.
The authors write, "In this randomized clinical trial, the triple aim of improved care, improved health, and lower costs was achieved in an enhanced medical home providing comprehensive care to high- risk children with chronic illness compared with usual care. These findings from a single site of selected patients with a limited number of clinicians require study in larger, broader populations before conclusions about generalizability to other settings can be reached."
The study is published in JAMA.