Table 2.
Summary of Findings for the Joint Principles of the Patient Centered Medical Home impact on Hemoglobin A1C.
| Illustrative Comparative Risks1 (95% CI) | |||||
|---|---|---|---|---|---|
| Assumed Risk | Corresponding Risk | ||||
| Outcomes | Control | PCMH Principles | No of Participants (Studies) | Quality of the Evidence (GRADE)(2) | References |
| Impact of personal physician on change in A1C (PCMH 1) | Not estimable | Not estimable | 0 (0) | Not estimable | No high-quality studies identified. |
| Impact of nurse care management on change in A1C (PCMH 2.A) Follow-up: mean 15 months Baseline mean A1C of all 5 studies: 8.24 | The mean impact of the control intervention (PCMH 2.A) was −0.37 points | The mean impact of nurse care management on change in A1C (PCMH 2.A) in the intervention groups was 0.36 lower than control (0.43-0.28 lower) | 7174 (5 studiesa) | High b,c | Meta-analysis Dorr et al,17 Aubert et al,23 Mousques et al,24 and Krein et al25 Review Gary et al26 |
| Impact of pharmacist care management on change in A1C (PCMH 2.B) Follow-up: mean 24 months Baseline mean A1C of all 5 studies: 10.06 | The mean impact of the control intervention (PCMH 2.B) was −0.42 points | The mean impact of pharmacist care management on change in A1C (PCMH 2.B) in the intervention groups was 0.76 lower than control (0.93-0.59 lower) | 972 (5 studiesa) | High a,b,c | Meta-analysis Johnson et al,27 Choe et al,28 Neto et al,29 and Salvo et al30 Review Jameson and Baty31 |
| Impact of whole-person orientation on change in A1C (PCMH 3) Follow-up: mean 9 months Baseline mean A1C of 7 (excludes Rocco 2011—not reported) studies: 8.87 | The mean impact of the control intervention (PCMH 3) −0.4 points | The mean impact of whole-person orientation on change in A1C (PCMH 3) in the intervention groups was 0.72 lower than control (0.98-0.45 lower) | 983 (8 studiesa) | High a | Meta-analysis Song et al,32 Hornsten et al,33 Kirsh et al,34 Schillinger et al,35 and Polonsky et al36 Review Naik et al,37 Glasgow et al,38 and Rocco et al39 |
| Impact of care coordination with information technology on change in A1C (PCMH 4.A) Follow-up: mean 9 months | See commentd | See commentd | 1841 (4 studies) | High c,e | Review McCarrier et al,40 Piette et al,41 Shea et al,42 and Stone et al43 |
| Impact of depression integration on change in A1C (PCMH 4.B) Follow-up: mean 9.75 months | See commentd | See commentd | 1631 (6 studies) | Moderate f,g | Review Katon et al,44 Piette et al,45 Pouwer et al,46 Snoek et al,47 Bogner and de Vries,48 and Ismail et al49 |
| Impact of care manager integrated into primary care office (PCMH 4.C) Follow-up: mean 12 months | Single study identified | Single study identified | 545 (1 study) | See commentb | Review Davidson et al50 |
| Impact of self-monitoring of blood glucose integrated with technology on change in A1C (PCMH 5.A) Follow-up: mean 9 months | See commentd | See commentd | 914 (6 studies) | High d | Review Rodriguez-Idigoras et al,51 Istepanian et al,52 Farmer et al,53 Augstein et al,54 and Lim et al55 |
| Impact of clinical decision support for use of clinical practice guidelines on A1C (PCMH 5.B) Follow-up: mean 21 months | See commentd | See commentd | 10287 (7 studiesa) | Moderate f | Review O'Connor et al, 2011,56 Guldberg et al,57 Maclean et al,58 Weitzman et al,59 Benjamin et al,60 Ziemer et al,61 and Holbrook et al62 |
| Impact of use of electronic medical records on change in A1C (PCMH 5.C) Follow-up: mean 48 months | Single study identified | Single study identified | 2556 (1 study) | See commentb | Review O'Connor et al63 |
| Impact of enhanced access on change in A1C (PCMH 6)—not measured | Not estimable | Not estimable | – | Not estimable | No high-quality studies identified |
| Impact of payment on change in A1C (PCMH 7)—not measured | Not estimable | Not estimable | – | Not estimable | No high-quality studies identified |
Abbreviations: CI, Confidence interval; PCMH, Patient Centered Medical Home.
1The basis for the assumed risk (eg, the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
2GRADE Working Group grades of evidence: high quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
a≥50% RCT.
bObservational study design introduced risk.
cAt least 2 studies had a RR > 2.
dData not pooled due to heterogeneity.
eTwo studies had SD close to or encompassing 0.
fDiffering estimates of effect.
gWide confidence intervals noted.