Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

Jaén, Carlos Roberto; Ferrer, Robert L.; Miller, William L.; Palmer, Raymond F.; Wood, Robert A.; Davila, Marivel; Stewart, Elizabeth; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.

doi:10.1370/afm.1121

Cited by 170 publications

(176 citation statements)

References 31 publications

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“…15,16 A greater understanding is needed of the organizational factors influencing a practice's degree of PCMH adoption, including the awareness and commitment not only of practice leadership and primary care providers, but of all employees. [17][18][19] A second potential reason for the lack of perception among respondents of structural changes intended to benefit them is the targeted population. Although practices have adopted PCMH standards uniformly for all patients, for our study, we chose to focus on patients that had at least one chronic condition, namely, diabetes and/or hypertension.…”

Section: Discussionmentioning

confidence: 99%

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

et al. 2015

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BACKGROUND: What patients perceive and experience within a patient-centered medical home (PCMH) is an understudied area, and to date, the patient perspective has not been an integral component of existing PCMH measurement standards. However, upcoming guidelines necessitate the use of patient-reported experiences and satisfaction in evaluations of practice and provider performance. OBJECTIVE: To characterize patients' experiences with care after PCMH adoption and their understanding and perceptions of the PCMH model and its key components, and to compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. DESIGN: Qualitative study. PARTICIPANTS: Adult patients with diabetes and/or hypertension (n=48). APPROACH: We surveyed and ranked all PCMH adult primary care practices affiliated with one academic medical center with at least three providers (n=23), using an instrument quantifying the degree of PCMH adoption. We purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether responses varied by degree of PCMH adoption or patient race/ethnicity. We conducted semi-structured telephone interviews with patients about their experiences with care and their perceptions and understanding of key PCMH domains. Interviews were recorded, transcribed, and imported into NVivo 10 for coding and analysis, using a modified grounded theory approach. KEY RESULTS: We found that patients uniformly lacked awareness of the PCMH concept, and the vast majority perceived no PCMH-related structural changes, regardless of the degree of practice-reported PCMH adoption or the patient's race/ethnicity. Despite this lack of awareness, patients overwhelmingly reported positive relationships with their provider and positive overall experiences. CONCLUSIONS: As we continue to redesign primary care delivery with an emphasis on patient experience measures as performance metrics, we need to better understand what, if any, aspects of practice structure relate to patient experience and satisfaction with care.

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Section: Discussionmentioning

confidence: 99%

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

et al. 2015

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“…A recent review of 8 published studies found a small, positive effect of PCMH recognition on patient experience; however, only 3 studies included children, 3 and 1 of those found no effect on patient experience. 9 Therefore, results are mixed, and more research on child patient experiences is needed to inform the next steps in the transformation of health care systems.…”

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confidence: 99%

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Harder

Krulewitz

Jones

et al. 2016

The Journal of the American Board of Family Medicine

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Introduction: Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation.Methods: This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n ‫؍‬ 21) and non-PCMH (n ‫؍‬ 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS).Results: A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P ‫؍‬ .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P ‫؍‬ .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively.Conclusions: Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. (J Am Board Fam Med 2016;29:60 -68.)

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“…5,6 Despite the emphasis placed on comprehensiveness, patient-centeredness, and extended access in prevailing health care redesign efforts, how these attributes influence utilization of preventive services at the national level is little studied. Existing research consists of ecological studies, 7 small pilot projects, 8 and larger comparative studies. 9,10 However, nearly all have been limited to a relatively narrow group of patients (eg, those with certain chronic diseases, geriatric patients, pediatric patients) and/or to a single geographic site (eg, managed care organizations, hospital regions, single primary care practices).…”

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confidence: 99%