A Comparison of Assertive Community Treatment Fidelity Measures and Patient-Centered Medical Home Standards

As guidelines for assertive community treatment (ACT) increasingly emphasize treatment of general medical conditions, ACT has begun to take on the appearance of a patient-centered medical home. Noting the similarity, the authors compared fidelity standards for both models and found significant overlap. With some adjustments, particularly in the supervision of general medical care, high-fidelity ACT teams could qualify as medical homes, the authors concluded. ObjectiveThis study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation.MethodsThe authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards.ResultsPCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy “must-pass” elements of the standards.ConclusionsACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases.