Capsule Commentary on Woodard et al., Impact
of Patient-Centered Medical Home Implementation on Diabetes
Control in the Veterans Health Administration
Lisa Stehno-Bittel, PhD and Lisa VanHoose, PhD, MPH, MSPT
University of Kansas Medical Center, Kansas City, KS, USA.
J Gen Intern Med
© Society of General Internal Medicine 2018
ince the induction of the Affordable Care Act, care out-
comes for Patient-Centered Medical Homes (PCMH)
while important, have proven difficult to assess. The Veterans
Affairs Healthcare system version of the PCMH is the Patient-
Aligned Care which was launched in 2010 and offers an
opportunity to compare outcomes to the traditional provider
model that was in place prior to implementation of PACT.
A previous study found significant improvement in lipid
values and blood pressure with PACT implementation in
over 800 VA primary care clinics
. The study reviewed
here analyzed PACT’s impact on glycemic control among
. The authors focused on two out-
comes as measures of the quality of care: glycemic control
(hemoglobinA1c < 9%) and lipid management (low-density
lipoprotein cholesterol (LDL-C < 100 mg/dL). Tracking over
20,000 diabetic patients demonstrated that the percentage that
attained HbA1c levels below 9% declined in the PACT sys-
tem, while LDL-C control improved slightly. However, this
improvement disappeared when adjusted for patient, provider,
and facility. While the results should not be surprising, be-
cause in the general population only 29% of diabetics meet the
target HbA1c levels
, they do not suggest that PACT did better
than traditional models of care.
The authors also investigated the PACT’s influence on
gender and racial health disparities. A narrowing of the glyce-
mic control gap between non-Hispanic White and Black pa-
tients was reported. However, the difference was insignificant
with the introduction of gender into the model, which may be
due to heterogeneity of female primary care delivery within
the VA system
. Although PCMH/PACT adoption has
increased significantly, a recent systematic review reported
that the number of high quality publications are limited
While PACT had no impact on diabetic outcomes, Woodward
et al. supports previous publications suggesting small im-
provements toward health equity with PACT that are promis-
ing and should continue to be investigated.
Corresponding Author: Lisa Stehno-Bittel, PhD; University of
Kansas Medical Center, Kansas City, KS, USA (e-mail: lbittel@kumc.
Compliance with Ethical Standards:
Conflict of Interest: The authors declare that they have no conflict of
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