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

Journal of General Internal Medicine, May 2016

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.

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

Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis Yue Gao 2 Robert S. Nocon Kathryn E. Gunter Ravi Sharma 1 Quyen Ngo-Metzger 0 Lawrence P. Casalino 3 Marshall H. Chin 2 0 U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services , Rockville, MD , USA 1 Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services , Rockville, MD , USA 2 Section of General Internal Medicine, Department of Medicine, The University of Chicago , Chicago, IL , USA 3 Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, NY , USA 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 10.213.3]), 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 statesupported 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. health center; medical home; vulnerable populations; disparities; financial incentives; J Gen Intern Med 31(9); 1041-51 DOI; 10; 1007/s11606-016-3729-8 © Society of General Internal Medicine 2016 - I n 2014, 1278 Health Resources and Services Administration (HRSA)-supported Health Center Program grantees served 22.9 million patients, constituting a critical portion of the primary care safety net for vulnerable patients.1 Organizations such as the HRSA have encouraged and supported HC adoption of the patient-centered medical home (PCMH) model,2–4 which aims to provide comprehensive and coordinated patient-centered care, deliver accessible services, and focus on quality. Therefore, it has the potential to improve the care experience and the quality of care, and to reduce emergency room visits, hospital admissions, and total cost.5–8 It is important to identify potential ways to increase the capability of HCs to serve as PCMHs, and specifically to identify key characteristics associated with PCMH capability in HCs. Previous studies have examined similar questions in a variety of settings using different outcomes, including: medical home processes,9–11 capacity,12,13 and infrastructure,14,15 care management processes,16 structural capabilities,17,18 program implementation progress index,19 and the percentage point or the level of recognition achieved on the National Committee on Quality Assurance (NCQA) PCMH standards.20–23 These studies have identified a few characteristics associated with medical home capability, such as practice size, type, and ownership, external incentives, organizational relationships, health information technology (HIT), and patient and neighborhood demographics and socioeconomic characteristics. Other studies have identified characteristics associated with individuals’ access to care that are consistent with the principles of the medical home, such as patient age, race/ ethnicity, insurance type, household income, primary language, disease burden, and neighborhood characteristics.24–26 However, these studies are limited in their ability to identify specific characteristics associated with PCMH capability in HCs and the magnitude of their impact. Most studies have focused on non-HCspecific s (...truncated)


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Yue Gao MPH, Robert S. Nocon MHS, Kathryn E. Gunter MPH, MSW, Ravi Sharma PhD, Quyen Ngo-Metzger MD, MPH, Lawrence P. Casalino MD, PhD, Marshall H. Chin MD, MPH. Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis, Journal of General Internal Medicine, 2016, pp. 1041-1051, Volume 31, Issue 9, DOI: 10.1007/s11606-016-3729-8