Using the evidence: PCMH and patient-centered outcomes research

The key to understanding the patientcentered medical home (PCMH) lies in the first two words: patient centered. PCMH has emerged as an attractive model of care that holds the potential to improve the quality, safety, and effectiveness of health care. But the model makes sense only if it is rigorously designed and implemented with the patient at the center of every health care transaction. Regular readers of JAPhA likely are familiar with another patient-centric endeavor that is of great general interest: patient-centered outcomes research. This field of inquiry, sometimes known as comparative effectiveness research, is the comparison of existing health care interventions to give patients and providers objective and evidence-based information about relative benefits and harms of different treatment options. Patient-centered outcomes research helps patients confront everyday decisions about care under real-world circumstances.1 PCMH and patient-centered outcomes research both should work, ideally in tandem, to promote safer, higher quality, more patient-centric health care. As the nation’s lead federal agency advancing health services research to improve the quality of health care, the Agency for Healthcare Research and Quality (AHRQ) actively supports both endeavors. Pharmacists play an integral role in ensuring that patients receive safe and effective therapies and helping to create an environment of shared decision making and therefore will benefit from the close association of PCMH and patient-centered outcomes research. AHRQ supports PCMH by advancing its evidence base and by convening and working with government and private stakeholders to ensure that the best ideas are shared broadly. AHRQ defines PCMH as encompassing the following five principles: ■ A patient-centered orientation toward the whole person ■ Comprehensive, team-based care ■ Care coordinated and/or integrated across all elements of the system ■ Continuous access to care, with shorter waits to get appointments and alternative methods of communication ■ A systems-based approach to quality and safety, including the use of evidence-based medicine2–4 To support AHRQ’s efforts for PCMH, a new website (www.pcmh.ahrq.gov) was developed for health care decision makers and researchers. The site provides searchable access to a rich database of publications and other resources on the medical home, including access to AHRQ-funded white papers. The agency has awarded grants that will study primary care practices’ experiences in transforming into medical homes and commissioned retrospective evaluations of longstanding efforts to reengineer primary care. AHRQ also is integrating its work on health information technology (HIT) into its PCMH research as we strive to make HIT an “agent of change” for PCMH. Patient-centered outcomes research is a central pillar of our collective work to improve the health care system. This field of research received an unprecedented federal investment in 2009 under the American Recovery and Reinvestment Act. The subsequent Affordable Care Act of 2010 created the PatientCentered Outcomes Research Institute as an independent, not-for-profit entity supported by both private and public sector funding, ensuring that this research will be closely integrated into health reform efforts going forward. AHRQ’s role in patient-centered outcomes research also is well established. AHRQ has conducted and supported this research since the creation of the Effective Health Care Program in 2005. The program already has produced much research that is of great interest to pharmacists, such as guides on medications to reduce the risk of developing primary breast cancers and on the use of insulin analogs. (The full scope of the program’s work can be found at http://effectivehealthcare.ahrq.gov.) From its start, AHRQ’s Effective Health Care Program has conducted research and dissemination on outcomes, comparative clinical effectiveness, and appropriateness of health care interventions, including prescription drugs. Its goal has been to provide patients, clinicians, and others with reliable, evidence-based health care information. This is the cornerstone of patientcentered treatment—and of PCMH. PCMH recognizes that every patient is different, while patient-centered outcomes research seeks to determine which treatment works best for whom under which conditions. The integration of these endeavors and active participation of pharmacists will help build a health care system in which the right patient receives the right care at the right time, every time.