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Patient-centered medical home intervention at an internal medicine resident safety-net clinic.

ABSTRACT: The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings.We implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls.Using a cross-sectional design, we measured the effect on patient and resident satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey and a validated teaching clinic survey, respectively. Both surveys were conducted at baseline and 1 year after the intervention. We also measured the effect on emergency department and hospital utilization.Following implementation of our intervention, the clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved from 35 to 53 of 100 possible points, although our clinic did not achieve all must-pass elements to qualify as a PCMH. During the 1-year study period, 4676 patients were exposed to the intervention; 39.9% of these used at least 1 program component. Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, and the composite satisfaction rating increased from 48% to 65% in the intervention clinic vs from 50% to 59% in the control sites (P?=?.04). The improvements were particularly notable for questions relating to access. For example, satisfaction with urgent appointment scheduling increased from 12% to 53% in the intervention clinic vs from 14% to 18% in the control clinics (P?

SUBMITTER: Hochman ME

PROVIDER: S-EPMC4254756 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Patient-centered medical home intervention at an internal medicine resident safety-net clinic.

Hochman Michael E ME Asch Steven S Jibilian Arek A Chaudry Bharat B Ben-Ari Ron R Hsieh Eric E Berumen Margaret M Mokhtari Shahrod S Raad Mohamad M Hicks Elisabeth E Sanford Crystal C Aguirre Norma N Tseng Chi-hong CH Vangala Sitaram S Mangione Carol M CM Goldstein David A DA

JAMA internal medicine 20131001 18

<h4>Importance</h4>The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings.<h4>Design, setting, and participants</h4>We implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls.<h4>Main outcomes and measures</h4>Using a cross-sectional design, we measured the effect on patient and resident satis ...[more]

PMID: 24006034

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Project description:BackgroundExisting tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics.ObjectiveDevelop a scale to measure PCMH adoption in safety-net clinics.Research designCross-sectional survey.SubjectsSixty-five clinics in five states.Main measuresFifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0-100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption.ResultsThe SNMHS had high internal consistency reliability (Cronbach's alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r = 0.64, p < 0.0001) and the PCMH-A (r = 0.56, p < 0.001). The mean SNMHS score was 61 ± SD 13. Among the subscales, External Coordination (66 ± 16) and Access and Communication (65 ± 14) had the highest mean scores, while Quality Improvement (55 ± 17) and Care Management (55 ± 16) had lower mean scores. Clinic characteristics positively associated with total SNMHS score were having more providers (β 15.8 95% CI 8.1-23.4 >8 provider FTEs compared to <4 FTEs) and participation in financial incentive programs (β 8.4 95% 1.6-15.3).ConclusionThe SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.

Dataset Information

Patient-centered medical home intervention at an internal medicine resident safety-net clinic.

Publications

Patient-centered medical home intervention at an internal medicine resident safety-net clinic.

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