Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices
- First Online:
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.
KEY WORDSprimary care quality improvement health policy patient centered care
- 1.Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academies Press; 2001.Google Scholar
- 8.Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington, D.C.: The National Academies Press; 2006.Google Scholar
- 9.Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;19(2):CD000259.Google Scholar
- 10.Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press; 2002.Google Scholar
- 15.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.
- 16.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.
- 17.National Center for Quality Assurance. NCQA Program to Evaluate Patient-Centered Medical Homes: Press Release; 2008, January 8.Google Scholar
- 21.Tax Relief and Health Care Act of 2006, Pub. L. No. 109–432, 120 Stat. 2922 (Dec 20, 2006).Google Scholar
- 27.MHQP website. http://www.mhqp.org. Accessed September 30, 2008.
- 32.Institute of Medicine. Key Capabilities of an Electronic Health Record System. Washington, D.C.: National Academies Press; 2003.Google Scholar