Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices
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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
We thank Katherine Howitt, M.A. for invaluable assistance in fielding the survey. We thank the Massachusetts Medical Society for helpful comments on early drafts of the survey instrument and for its encouragement of physician respondent participation.
This study was supported by the Commonwealth Fund. Dr. Friedberg was supported by a National Research Service Award from the Health Resources and Services Administration (5 T32 HP11001 20).
Conflict of Interest
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