Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied.
To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices.
One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database.
Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs).
Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2–74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics.
Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments.
- Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press, Washington, D.C.
- Shortell, SM, Rundall, TG, Hsu, J (2007) Improving patient care by linking evidence-based medicine and evidence-based management. JAMA 298: pp. 673-676 CrossRef
- Chassin, MR, Galvin, RW (1998) The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 280: pp. 1000-1005 CrossRef
- Grumbach, K, Bodenheimer, T (2002) A primary care home for Americans: putting the house in order. JAMA 288: pp. 889-893 CrossRef
- Bergeson, SC, Dean, JD (2006) A systems approach to patient-centered care. JAMA 296: pp. 2848-2851 CrossRef
- Casalino, LP (2005) Disease management and the organization of physician practice. JAMA 293: pp. 485-488 CrossRef
- Bodenheimer, T, Lorig, K, Holman, H, Grumbach, K (2002) Patient self-management of chronic disease in primary care. JAMA 288: pp. 2469-2475 CrossRef
- Performance Measurement: Accelerating Improvement. The National Academies Press, Washington, D.C.
- Jamtvedt, G, Young, JM, Kristoffersen, DT, O’Brien, MA, Oxman, AD (2006) Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 19: pp. CD000259
- Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press, Washington, D.C.
- Murray, M, Berwick, DM (2003) Advanced access: reducing waiting and delays in primary care. JAMA 289: pp. 1035-1040 CrossRef
- Bates, DW, Ebell, M, Gotlieb, E, Zapp, J, Mullins, HC (2003) A proposal for electronic medical records in U.S. primary care. J Am Med Inform Assoc 10: pp. 1-10 CrossRef
- Bodenheimer, T, Grumbach, K (2003) Electronic technology: a spark to revitalize primary care?. JAMA 290: pp. 259-264 CrossRef
- Bodenheimer, T (2006) Primary care-will it survive?. N Engl J Med 355: pp. 861-864 CrossRef
- American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint principles of the patient-centered medical home. March 2007; www.medicalhomeinfo.org/Joint%20Statement.pdf. Accessed September 30, 2008.
- American College of Physicians. The advanced medical home: a patient-centered physician-guided model of health care. January 2006; http://www.hhs.gov/healthit/ahic/materials/meeting03/cc/ACP_Initiative.pdf. Accessed September 30, 2008.
- National Center for Quality Assurance. NCQA Program to Evaluate Patient-Centered Medical Homes: Press Release; 2008, January 8.
- Martin, JC, Avant, RF, Bowman, MA (2004) The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med 2: pp. S3-S32
- Davis, K, Schoenbaum, SC, Audet, AM (2005) A 2020 vision of patient-centered primary care. J Gen Intern Med 20: pp. 953-957 CrossRef
- Goroll, AH, Berenson, RA, Schoenbaum, SC, Gardner, LB (2007) Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med 22: pp. 410-415 CrossRef
- Tax Relief and Health Care Act of 2006, Pub. L. No. 109–432, 120 Stat. 2922 (Dec 20, 2006).
- Robinson, JC (1998) Consolidation of medical groups into physician practice management organizations. JAMA 279: pp. 144-149 CrossRef
- Robinson, JC, Casalino, LP (1996) Vertical integration and organizational networks in health care. Health Aff 15: pp. 7-22 CrossRef
- Berenson, RA, Hammons, T, Gans, DN (2008) A house is not a home: keeping patients at the center of practice redesign. Health Aff 27: pp. 1219-1230 CrossRef
- Audet, AM, Doty, MM, Shamasdin, J, Schoenbaum, SC (2005) Measure, learn, and improve: physicians’ involvement in quality improvement. Health Aff 24: pp. 843-853 CrossRef
- Friedberg, MW, Coltin, KL, Pearson, SD (2007) Does affiliation of physician groups with one another produce higher quality primary care?. J Gen Intern Med 22: pp. 1385-1392 CrossRef
- MHQP website. http://www.mhqp.org. Accessed September 30, 2008.
- Simon, SR, Kaushal, R, Cleary, PD (2007) Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inform Assoc 14: pp. 110-117 CrossRef
- Casalino, L, Gillies, RR, Shortell, SM (2003) External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA 289: pp. 434-441 CrossRef
- Mehrotra, A, Epstein, AM, Rosenthal, MB (2006) Do integrated medical groups provide higher-quality medical care than individual practice associations?. Ann Intern Med 145: pp. 826-833
- Li, R, Simon, J, Bodenheimer, T (2004) Organizational factors affecting the adoption of diabetes care management processes in physician organizations. Diabetes Care 27: pp. 2312-2316 CrossRef
- Key Capabilities of an Electronic Health Record System. National Academies Press, Washington, D.C.
- Bodenheimer, T, Wang, MC, Rundall, TG (2004) What are the facilitators and barriers in physician organizations’ use of care management processes?. Jt Comm J Qual Saf 30: pp. 505-514
- Shortell, SM, Marsteller, JA, Lin, M (2004) The role of perceived team effectiveness in improving chronic illness care. Med Care 42: pp. 1040-1048 CrossRef
- Liang, K, Zeger, S (1986) Longitudinal data analysis using generalized linear models. Biometrika 73: pp. 13-22 CrossRef
- Zeger, SL, Liang, KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42: pp. 121-130 CrossRef
- Schmittdiel, J, McMenamin, SB, Halpin, HA (2004) The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations. Prev Med 39: pp. 1000-1006 CrossRef
- Rittenhouse, DR, Casalino, LP, Gillies, RR, Shortell, SM, Lau, B (2008) Measuring the medical home infrastructure in large medical groups. Health Aff 27: pp. 1246-1258 CrossRef
- Casalino, LP, Devers, KJ, Lake, TK, Reed, M, Stoddard, JJ (2003) Benefits of and barriers to large medical group practice in the United States. Arch Intern Med 163: pp. 1958-1964 CrossRef
- Burt, CW, Sisk, JE (2005) Which physicians and practices are using electronic medical records?. Health Aff 24: pp. 1334-1343 CrossRef
- Simon, SR, Kaushal, R, Cleary, PD (2007) Physicians and electronic health records: a statewide survey. Arch Intern Med 167: pp. 507-512 CrossRef
- Donabedian, A (1966) Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly 44: pp. 166-203 CrossRef
- Bodenheimer, T (2008) Coordinating care-a perilous journey through the health care system. N Engl J Med 358: pp. 1064-1071 CrossRef
- Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices
Journal of General Internal Medicine
Volume 24, Issue 2 , pp 162-169
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- primary care
- quality improvement
- health policy
- patient centered care
- Industry Sectors
- Author Affiliations
- 1. Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- 2. Harvard School of Public Health, Boston, MA, USA
- 3. Tufts University Medical School, Blue Cross/Blue Shield of Massachusetts, Boston, MA, USA
- 4. Harvard Pilgrim Health Care, Wellesley, MA, USA
- 5. Massachusetts Health Quality Partners, Watertown, MA, USA