Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2016 May 25

PMID 27216480

Citations 7

Authors

Yue Gao

Robert S Nocon

Kathryn E Gunter

Ravi Sharma

Quyen Ngo-Metzger

Lawrence P Casalino

Marshall H Chin

Affiliations

Soon will be listed here.

Abstract

Background: The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations.

Objective: To identify characteristics associated with HCs' PCMH capability.

Design: Cross-sectional analysis of a national dataset of Federally Qualified Health Centers (FQHCs) in 2009. Data for PCMH capability, HC, patient, neighborhood, and regional characteristics were combined from multiple sources.

Participants: A total of 706 (70 %) of 1014 FQHCs from the Health Resources and Services Administration Community Health Center Program, representing all 50 states and the District of Columbia.

Main Measures: PCMH capability was scored via the Commonwealth Fund National Survey of FQHCs through the Safety Net Medical Home Scale (0 [worst] to 100 [best]). HC, patient, neighborhood, and regional characteristics (all analyzed at the HC level) were measured from the Commonwealth survey, Uniform Data System, American Community Survey, American Medical Association physician data, and National Academy for State Health Policy data.

Key Results: Independent correlates of high PCMH capability included having an electronic health record (EHR) (11.7-point [95 % confidence interval, CI 10.2-13.3]), more types of financial performance incentives (0.7-point [95 % CI 0.2-1.1] higher total score per one additional type, maximum possible = 10), more types of hospital-HC affiliations (1.6-point [95 % CI 1.1-2.1] higher total score per one additional type, maximum possible = 6), and location in certain US census divisions. Among HCs with an EHR, location in a state with state-supported PCMH initiatives and PCMH payments was associated with high PCMH capability (2.8-point, 95 % CI 0.2-5.5). Other characteristics had small effect size based on the measure unit (e.g. 0.04-point [95 % CI 0-0.08] lower total score per one percentage point more minority patients), but the effects could be practically large at the extremes.

Conclusions: EHR adoption likely played a role in HCs' improvement in PCMH capability. Factors that appear to hold promise for supporting PCMH capability include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.

Citing Articles

Reducing Rural and Urban Disparities in Potentially Preventable Hospitalizations: Evidence of Hospital-Based Health Information Technology and Enabling Services.

Amaize A, Barath D, Wang M, Chen J Telemed J E Health. 2023; 29(10):1455-1464.

PMID: 36791320 PMC: 10589465. DOI: 10.1089/tmj.2022.0476.

Early experience of the quality improvement award program in federally funded health centers.

Jin J, Bolton J, Nocon R, Huang E, Hoang H, Sripipatana A Health Serv Res. 2022; 57(5):1070-1076.

PMID: 35396732 PMC: 9441276. DOI: 10.1111/1475-6773.13986.

Factors associated with federally qualified health center financial performance.

Jung D, Huang E, Mayeda E, Tobey R, Turer E, Maxwell J Health Serv Res. 2022; 57(5):1058-1069.

PMID: 35266139 PMC: 9441282. DOI: 10.1111/1475-6773.13967.

Implementation of a patient centred medical home (PCMH) initiative in general practices in New South Wales, Australia.

Metusela C, Dijkmans-Hadley B, Mullan J, Gow A, Bonney A BMC Fam Pract. 2021; 22(1):120.

PMID: 34148554 PMC: 8215740. DOI: 10.1186/s12875-021-01485-x.

Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process.

Mendel P, Chen E, Green H, Armstrong C, Timbie J, Kress A Health Serv Res. 2017; 53(4):2523-2546.

PMID: 29243823 PMC: 6051988. DOI: 10.1111/1475-6773.12803.

References

Casalino L, Gillies R, Shortell S, Schmittdiel J, Bodenheimer T, Robinson J . External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003; 289(4):434-41. DOI: 10.1001/jama.289.4.434. View

Rittenhouse D, Casalino L, Shortell S, McClellan S, Gillies R, Alexander J . Small and medium-size physician practices use few patient-centered medical home processes. Health Aff (Millwood). 2011; 30(8):1575-84. DOI: 10.1377/hlthaff.2010.1210. View

Jones E, Furukawa M . Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010-12. Health Aff (Millwood). 2014; 33(7):1254-61. DOI: 10.1377/hlthaff.2013.1274. View

Nelson K, Helfrich C, Sun H, Hebert P, Liu C, Dolan E . Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014; 174(8):1350-8. DOI: 10.1001/jamainternmed.2014.2488. View

Hearld L, Weech-Maldonado R, Asagbra O . Variations in patient-centered medical home capacity: a linear growth curve analysis. Med Care Res Rev. 2013; 70(6):597-620. DOI: 10.1177/1077558713498117. View

Rittenhouse D, Schmidt L, Wu K, Wiley J . Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net. Health Serv Res. 2013; 49(1):75-92. PMC: 3922467. DOI: 10.1111/1475-6773.12080. View

Solberg L, Stuck L, Crain A, Tillema J, Flottemesch T, Whitebird R . Organizational factors and change strategies associated with medical home transformation. Am J Med Qual. 2014; 30(4):337-44. DOI: 10.1177/1062860614532307. View

Knapp C, Woodworth L, Fernandez-Baca D, Baron-Lee J, Thompson L, Hinojosa M . Factors associated with a patient-centered medical home among children with behavioral health conditions. Matern Child Health J. 2012; 17(9):1658-64. DOI: 10.1007/s10995-012-1179-4. View

Shi L, Lock D, Lee D, Lebrun-Harris L, Chin M, Chidambaran P . Patient-centered Medical Home capability and clinical performance in HRSA-supported health centers. Med Care. 2015; 53(5):389-95. PMC: 4530496. DOI: 10.1097/MLR.0000000000000331. View

10.

Birnberg J, Drum M, Huang E, Casalino L, Lewis S, Vable A . Development of a safety net medical home scale for clinics. J Gen Intern Med. 2011; 26(12):1418-25. PMC: 3235610. DOI: 10.1007/s11606-011-1767-9. View

11.

Hollingsworth J, Saint S, Sakshaug J, Hayward R, Zhang L, Miller D . Physician practices and readiness for medical home reforms: policy, pitfalls, and possibilities. Health Serv Res. 2011; 47(1 Pt 2):486-508. PMC: 3393004. DOI: 10.1111/j.1475-6773.2011.01332.x. View

12.

Kern L, Edwards A, Kaushal R . The patient-centered medical home, electronic health records, and quality of care. Ann Intern Med. 2014; 160(11):741-9. DOI: 10.7326/M13-1798. View

13.

Zickafoose J, Gebremariam A, Davis M . Medical home disparities for children by insurance type and state of residence. Matern Child Health J. 2012; 16 Suppl 1:S178-87. PMC: 3444255. DOI: 10.1007/s10995-012-1008-9. View

14.

Hearld L, Hearld K, Hogan T . Community-level sociodemographic characteristics and patient-centered medical home capacity. Adv Health Care Manag. 2015; 16:23-50. DOI: 10.1108/s1474-823120140000016002. View

15.

Zheng B . Summarizing the goodness of fit of generalized linear models for longitudinal data. Stat Med. 2000; 19(10):1265-75. DOI: 10.1002/(sici)1097-0258(20000530)19:10<1265::aid-sim486>3.0.co;2-u. View

16.

Wiley J, Rittenhouse D, Shortell S, Casalino L, Ramsay P, Bibi S . Managing chronic illness: physician practices increased the use of care management and medical home processes. Health Aff (Millwood). 2015; 34(1):78-86. DOI: 10.1377/hlthaff.2014.0404. View

17.

Aysola J, Orav E, Ayanian J . Neighborhood characteristics associated with access to patient-centered medical homes for children. Health Aff (Millwood). 2011; 30(11):2080-9. DOI: 10.1377/hlthaff.2011.0656. View

18.

Nocon R, Sharma R, Birnberg J, Ngo-Metzger Q, Lee S, Chin M . Association between patient-centered medical home rating and operating cost at federally funded health centers. JAMA. 2012; 308(1):60-6. PMC: 3740269. DOI: 10.1001/jama.2012.7048. View

19.

Rittenhouse D, Casalino L, Gillies R, Shortell S, Lau B . Measuring the medical home infrastructure in large medical groups. Health Aff (Millwood). 2008; 27(5):1246-58. DOI: 10.1377/hlthaff.27.5.1246. View

20.

Friedberg M, Coltin K, Safran D, Dresser M, Schneider E . Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods. Arch Intern Med. 2010; 170(11):938-44. DOI: 10.1001/archinternmed.2010.110. View