How do rural patients benefit from the patient-centred medical home? A card study in the High Plains Research Network

Context The patient-centred medical home (PCMH) has become a dominant model for improving the quality and cost of primary care. Geographic isolation, small populations, privacy concerns and staffing requirements may limit implementation of the PCMH in clinical practice. Objective To determine the primary care provider perceived benefit of PCMH for patients in rural Colorado. Design, setting and participants The High Plains Research Network (HPRN) is a community and practice-based research network spanning 30 000 square miles in 16 counties in eastern Colorado. The HPRN consists of 58 practices, 120 primary care clinicians and 145 000 residents. Main outcome measures Providers' perceived benefit of PCMH for individual patients. Results Seventy-eight providers in 37 practices saw 1093 patients and completed 1016 surveys. There was wide variation among the provider-perceived benefits of PCMH elements ranging from 9% for group visits to 64% for electronic prescribing. Provider-perceived benefit was higher for patients with a chronic medical condition. Conclusions Rural primary care providers perceived patient benefit for numerous elements of the PCMH. There is need to consider what PCMH elements may be required in practice and what components might be optional. Our findings reveal that rural practices share PCMH aspirations including commitment to quality, safety, outcomes, cost reduction, and patient and provider satisfaction. These findings support the need for ongoing conversation about how to best provide a locally relevant medical home.