Effect of a Pragmatic, Cluster-randomized Controlled Trial on Patient Experience With Care

Dorr, David A.; Anastas, Tracy; Ramsey, Katrina; Wagner, Jesse; Sachdeva, Bhavaya; Michaels, LeAnn; Fagnan, Lyle J.

doi:10.1097/mlr.0000000000000552

Cited by 9 publications

(14 citation statements)

References 23 publications

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“…Studies of PACT and adult PCMH have most often assessed patient experience using survey data, with results that have included positive ( 11 ), negative ( 1 ), mixed ( 12 ), and no associations between PACT or PCMH implementation and patient experience ( 1 , 13 , 14 ). Despite the intense investment of resources, PACT does not appear to have shifted patient experience, at least not as captured in one regional survey of Veteran satisfaction ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Tuepker

Newell

Nicolaidis

et al. 2017

Journal of Patient Experience

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Background:The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date.Objective:We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which characteristics of care mattered most to their experiences.Method:Qualitative interviews were conducted with 32 veterans receiving primary care at 1 of 8 VA clinics in the northwest United States. Interviews were analyzed using an inductive–deductive hybrid approach by an interdisciplinary team that included a veteran patient.Result:Participants noticed recent positive changes, including improved communications and shorter waits in clinic, but rarely were aware of VA’s PCMH initiative; a strong relationship with the primary care provider and feeling cared for/respected by everyone involved in care delivery were key components of quality care. The needs of the veteran community as a whole also shaped discussion of care expectations.Conclusion:The PCMH model may provide benefits even when invisible to patients. Veteran awareness of population needs suggests a promising role for veteran involvement in further PCMH transformation efforts.

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Section: Introductionmentioning

confidence: 99%

Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Tuepker

Newell

Nicolaidis

et al. 2017

Journal of Patient Experience

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“…Researchers in most studies reported (8,18 –33) statistically significant results in at least one of the study’s patient experience outcome measures. Fourteen of the study’s (20,22 –29,31 –35) authors used comparison groups as a methodological design to measure patient experience from multiple health-care perspectives. Several teams of researchers (21,32,35) used data from large Medicare databases to conduct their studies.…”

Section: Resultsmentioning

confidence: 99%

“…The studies are categorized by their use of the CG-CAHPS survey to provide a synthesis of what is known about primary care quality from patient reports. The use of CG-CAHPS surveys’ results assisted health-care clinics, organizations, and payers to understand how patient experience reports related to (1) health-care delivery models (8,19,20,22,25,31,32,35); (2) interventions (26,33,34); (3) differences by patients’ characteristics and behaviors (18,21,24,29,30); (4) practice climate (27,28); and (5) responses to quality improvement initiatives (23,36).…”

Section: Resultsmentioning

confidence: 99%

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Patient Experience in Primary Care: A Systematic Review of CG-CAHPS Surveys

Holt

2018

Journal of Patient Experience

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The National Academy of Medicine’s (NAM) vision for 21st-century health care underscored the need for increased patient engagement and charged health-care researchers to develop tools to evaluate patient experience. The most widely studied patient experience tools are the Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. The Clinician and Group (CG)-CAHPS survey is the preferred patient experience survey for primary care, and thus a systematic review of patient reports from the CG-CAHPS empirical literature is ideal to appreciate the voice of health-care consumers. This systematic review revealed patient subjective reports regarding the acceptability of health-care delivery models, the effectiveness of interventions, the timeliness of care in different practice climates, and their responses to quality improvement initiatives. The synthesized results inform clinicians, organizations, and the health-care system where to prioritize and how to adapt services to efficiently provide equitable care, achieving the NAM’s vision for a patient-centered US health-care system.

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“…We then designed a pragmatic cluster randomized controlled trial based on these elements versus standard PCMH goals to explore whether they would improve measures of cost, utilization, and patient health and experience of care 28. Results from this trial showed improvements in patient experience of care which favored the intervention arm,29 but no previous findings have been reported regarding the cost and utilization outcomes of patients involved in this study. By attempting to evaluate and redefine the core components of effective primary care transformation, we sought to investigate whether the PCMH model could be further refined and improved.…”

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confidence: 99%

The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Cluster Randomized Controlled Trial

et al. 2021

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Background: Primary Care Medical Home (PCMH) redesign efforts are intended to enhance primary care's ability to improve population health and well-being. PCMH transformation that is focused on "high-value elements" (HVEs) for cost and utilization may improve effectiveness. Objectives:The objective of this study was to determine if a focus on achieving HVEs extracted from successful primary care transformation models would reduce cost and utilization as compared with a focus on achieving PCMH quality improvement goals.Research Design: A stratified, cluster randomized controlled trial with 2 arms. All practices received equal financial incentives, health information technology support, and in-person practice facilitation. Analyses consisted of multivariable modeling, adjusting for the cluster, with difference-in-difference results.Subjects: Eight primary care clinics that were engaged in PCMH reform.Measures: We examined: (1) total claims payments; (2) emergency department (ED) visits; and (3) hospitalizations among patients during baseline and intervention years.Results: In total, 16,099 patients met the inclusion criteria. Intervention clinics had significantly lower baseline ED visits (P = 0.02) and claims paid (P = 0.01). Difference-in-difference showed a decrease in ED visits greater in control than intervention (ED per 1000 patients: +56; 95% confidence interval: +96, +15) with a trend towards decreased hospitalizations in intervention (−15; 95% confidence interval: −52, +21). Costs were not different. In modeling monthly outcome means, the generalized linear mixed model showed significant differences for hospitalizations during the intervention year (P = 0.03).Discussion: The trial had a trend of decreasing hospitalizations, increased ED visits, and no change in costs in the HVE versus quality improvement arms.

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Effect of a Pragmatic, Cluster-randomized Controlled Trial on Patient Experience With Care

Abstract: Background-Health reform programs like the Patient-Centered Medical Home (PCMH) are intended to improve the Triple Aim. Previous studies on PCMHs have shown mixed effects, but High Value Elements (HVEs) are expected to improve the Triple Aim.

Cited by 9 publications

References 23 publications

Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Patient Experience in Primary Care: A Systematic Review of CG-CAHPS Surveys

The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Cluster Randomized Controlled Trial

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