he patient-centered medical home (PCMH) may help reduce the fragmentation and inefficiency of the US health care system. [1][2][3][4] The PCMH model focuses on team-based care to address patient needs and improve care experiences and outcomes while reducing costs. 5 Although several organizations provide PCMH recognition, 6,7 more than 13,000 US primary care practices, or 15% to 18% of all primary care practices, are recognized as PCMHs under the medical home standards of the National Committee for Quality Assurance (NCQA). 8,9 PCMH implementation requires changes to multiple aspects of primary care practice. 10 Full transformation may take years 11 and requires resources from leaders and staff. 12,13 Adopting the PCMH model entails a fundamental shift in orientation and culture. 14 NCQA included performance and quality improvement (QI) measurements as part of its sixth standard to drive more comprehensive measurement and use of patient experience data. Patient experience has been assessed using the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) survey supplemented with PCMH items-that is, the CAHPS PCMH survey. This survey includes questions assessing specific aspects of PCMH delivery such as access to care and self-management support.Research has assessed how health care providers and systems use patient experience survey data to improve patient care experiences [15][16][17][18][19] and make care more patient centered. Studies have documented that organizations and health care leaders encounter challenges in driving change. Case studies have shown how large systems use CAHPS data primarily for QI and have focused PCMH transformation on care delivery. [19][20][21][22][23] However, there has been little research examining how practice leaders use CAHPS and CAHPS PCMH survey data to improve patient experiences and support PCMH transformation. This paper examines the PCMH transformation experiences of a nationwide sample of 105 primary care practices. We investigate how practices administering different patient experience surveys used the resulting data for PCMH transformation and related QI efforts.

Background and Objectives: Delivering care as a patient-centered medical home (PCMH) is being widely adopted across the United States by primary care practices to better meet patient needs. A key PCMH element is measuring patient experience for practice improvement. The National Committee for Quality Assurance (NCQA) PCMH recognition program requires practices to both measure patient experience and engage in continuous practice/quality improvement to attain PCMH recognition and then throughout full PCMH transformation. The NCQA recommends but does not require that practices administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) clinician and group patient experience survey (CG-CAHPS) plus 14 CAHPS PCMH items, known as the CAHPS PCMH survey. We examine aspects of patient experience measured by practices with a varying number of years on their journey of PCMH transformation. Methods: We randomly selected practices from the 2008-2017 NCQA directory of practices that had applied for PCMH recognition based on region, physician count, number of years and level of PCMH recognition, and use of the CG-CAHPS PCMH survey. We collected characteristics of the practices from practice leader(s) knowledgeable about the practice's PCMH history and patient experience data. We confirmed the patient experience surveys used during their PCMH history and requested copies of their non-CAHPS survey(s). For practices not administering the recommended CG-CAHPS survey (53/105 practices), we obtained and coded the content of their non-CAHPS surveys (68%; 36/53). We mapped the patient experience domains and specific measures to the CG-CAHPS survey (versions 2.0 and 3.0), CAHPS PCMH item set (versions 2.0 and 3.0), and the available CG-CAHPS supplemental items. Results: Whether or not practices administered the CG-CAHPS items, most of them addressed topics contained in the CG-CAHPS survey such as Access to care, Provider communication, Office staff helpfulness/courteousness, Care coordination, and Shared decision-making. The most common CAHPS measures included were Office staff helpfulness/courteousness and Provider communication. Common non-CAHPS measures included were Ease of scheduling, Being informed about delays, and Provider helpfulness/courteousness. Conclusion: NCQA PCMH practices included CAHPS items on their patient experience surveys even if they did not administer the full CG-CAHPS survey or the recommended CAHPS PCMH survey. To enhance the usefulness of patient experience surveys for practices undergoing PCMH changes, additional CAHPS measures could be developed related to key areas of PCMH change, including expanded access to care (ie, after-hours and weekend visits, ease of scheduling, being informed about delays), use of shared decision-making, and improvements in provider communication (ie, the provider is courteous, communication by other clinical staff members with the patient). These additional measures would assist practice leaders in capturing the breadth and depth of their PCMH transformation and...

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