Hypertension Research https://doi.org/10.1038/s41440-020-0431-3 ARTICLE Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients James Rufus John 1,2 ● W Kathy Tannous 3 ● Amanda Jones 4 Received: 21 November 2019 / Revised: 18 February 2020 / Accepted: 24 February 2020 © The Japanese Society of Hypertension 2020 Abstract Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (-3.4 mmHg; 95% CI -5.1, -1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively. Keywords Collaborative care ● Patient-centered medical home ● Blood pressure ● Hypertension ● Chronic care model Introduction Hypertension persists as one of the leading causes of death and disability worldwide despite major advances in medical treatment and technologies [1, 2]. In Australia, it is estimated that one in three adults (34%) aged 18 years or older has high blood pressure (BP) (BP ≥ 140/90 mmHg or on antihypertensive medication), which is 6% higher than the average prevalence among high-income countries [3–5]. There is sound evidence suggesting that uncontrolled hypertension is a major risk factor for cardiovascular dis- eases (CVDs), including ischemic heart disease, stroke, heart failure, and chronic renal diseases [2, 6]. In addition to its health burden, hypertension is associated with a sig- nificant economic burden in terms of productivity-adjusted life years and its impact on the health care system, which accounted for direct costs of up to $1.8 billion in 2009 [7, 8]. In addition, data from general practices also indicate that hypertension is the most commonly reported problem (8 cases per 100 encounters) managed at the primary care level in Australia [9]. While hypertension is associated with significant health and economic ramifications, it is fortunate * James Rufus John james.john@rozettainstitute.com 1 Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia 2 Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW, Australia 3 School of Business, Western Sydney University, Parramatta, NSW 2150, Australia 4 Sonic Clinical Services, Sydney, NSW, Australia 1234567890();,: 1234567890();,: