The patient-centered medical home model, in which a team of providers delivers comprehensive, coordinated primary care, has been widely used in the primary care setting to improve quality of care and reduce health care costs. There is little evidence, however, that this model improves outcomes in low-income patients-or how it might potentially do so. Researchers reviewed studies evaluating patient-centered medical home interventions among low-income populations to determine which components of the model were implemented and if these reduced health care costs and improved patient outcomes and experience.

Of 467 articles reviewed, 33 were included in the final analysis. Using criteria from the Agency for Healthcare Research and Quality, the researchers rated 15 studies as low bias, 11 as medium bias, and seven as high bias. Most studies included five of the six components of the patient-centered medical home model (team-based care, care coordination, enhanced access to care, quality improvement evaluations, electronic medical records, and use of self-management interventions).

The overall effect size of the patient-centered medical homes model on health care outcomes in low-income patients ranged from small to intermediate. Patients enrolled in patient-centered medical homes had fewer ED visits and required less inpatient care. They were also more likely to adhere to and have follow-up treatment, and some studies showed increased use of primary care. Patient-centered medical homes also had a positive effect on quality of care and on patient and provider satisfaction with care. However, they had little effect on the overall cost of care in this patient population.

The authors note that implementation of patient-centered medical homes can be costly and that many interventions are needed to address the complex needs of low-income populations, who face other types of constraints in regard to the use and access of health care.

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