Original Article

Journal of General Internal Medicine

, Volume 24, Issue 2, pp 162-169

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

  • Mark W. FriedbergAffiliated withDivision of General Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolHarvard School of Public Health
  • , Dana G. SafranAffiliated withTufts University Medical School, Blue Cross/Blue Shield of Massachusetts
  • , Kathryn L. ColtinAffiliated withHarvard Pilgrim Health Care
  • , Marguerite DresserAffiliated withMassachusetts Health Quality Partners
  • , Eric C. SchneiderAffiliated withDivision of General Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolHarvard School of Public Health Email author 

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Abstract

Background

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.

Objective

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.

Design

Cross-sectional analysis.

Participants

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.

Measurements

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).

Main Results

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.

Conclusions

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.

KEY WORDS

primary care quality improvement health policy patient centered care