The patient-centered medical home (PCMH) is widely and vigorously promoted as the basis for primary care reform that will support a high-performing, cost-effective health care system.1 The PCMH involves a deceptively simple set of key structural practice features that have been proposed to result in enhanced access for routine primary care, improved delivery of preventive services, high-quality chronic disease management, and reduced emergency department and hospital utilization.1,2 The most definitive assessments of its success in improving quality and reducing utilization have been based in highly integrated health care systems and single-payer community-based practices,3 but this model of care is often promoted as the foundation for all primary care delivery, including the solo and small group practices that dominate the primary care delivery system.4 Advocates for the PCMH may be disappointed by the results of the study by Friedberg et al5 reported in this issue of JAMA. They need not be disappointed, but they should pay close attention to the study’s lessons.
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