Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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

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.

This is a preview of subscription content, log in to check access.

Figure 1
Figure 2

References

  1. 1.

    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academies Press; 2001.

  2. 2.

    Shortell SM, Rundall TG, Hsu J. Improving patient care by linking evidence-based medicine and evidence-based management. JAMA. 2007;298(6):673–676. Aug 8.

  3. 3.

    Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280(11):1000–1005. Sep 16.

  4. 4.

    Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA. 2002;288(7):889–893. Aug 21.

  5. 5.

    Bergeson SC, Dean JD. A systems approach to patient-centered care. JAMA. 2006;296(23):2848–2851. Dec 20.

  6. 6.

    Casalino LP. Disease management and the organization of physician practice. JAMA. 2005;293(4):485–488. Jan 26.

  7. 7.

    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–2475. Nov 20.

  8. 8.

    Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington, D.C.: The National Academies Press; 2006.

  9. 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.

  10. 10.

    Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press; 2002.

  11. 11.

    Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA. 2003;289(8):1035–1040. Feb 26.

  12. 12.

    Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A proposal for electronic medical records in U.S. primary care. J Am Med Inform Assoc. 2003;10(1):1–10. Jan–Feb.

  13. 13.

    Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA. 2003;290(2):259–264. Jul 9.

  14. 14.

    Bodenheimer T. Primary care-will it survive? N Engl J Med. 2006;355(9):861–864. Aug 31.

  15. 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. 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. 17.

    National Center for Quality Assurance. NCQA Program to Evaluate Patient-Centered Medical Homes: Press Release; 2008, January 8.

  18. 18.

    Martin JC, Avant RF, Bowman MA, et al. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(Suppl 1):S3–S32. Mar–Apr.

  19. 19.

    Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–957. Oct.

  20. 20.

    Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med. 2007;22(3):410–415. Mar.

  21. 21.

    Tax Relief and Health Care Act of 2006, Pub. L. No. 109–432, 120 Stat. 2922 (Dec 20, 2006).

  22. 22.

    Robinson JC. Consolidation of medical groups into physician practice management organizations. JAMA. 1998;279(2):144–149. Jan 14.

  23. 23.

    Robinson JC, Casalino LP. Vertical integration and organizational networks in health care. Health Aff. 1996;15(1):7–22. Spring.

  24. 24.

    Berenson RA, Hammons T, Gans DN, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff. 2008;27(5):1219–1230. Sep–Oct.

  25. 25.

    Audet AM, Doty MM, Shamasdin J, Schoenbaum SC. Measure, learn, and improve: physicians’ involvement in quality improvement. Health Aff. 2005;24(3):843–853. May–Jun.

  26. 26.

    Friedberg MW, Coltin KL, Pearson SD, et al. Does affiliation of physician groups with one another produce higher quality primary care? J Gen Intern Med. 2007;22(10):1385–1392. Oct.

  27. 27.

    MHQP website. http://www.mhqp.org. Accessed September 30, 2008.

  28. 28.

    Simon SR, Kaushal R, Cleary PD, et al. Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inform Assoc. 2007;14(1):110–117. Jan–Feb.

  29. 29.

    Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003;289(4):434–441. Jan 22–29.

  30. 30.

    Mehrotra A, Epstein AM, Rosenthal MB. Do integrated medical groups provide higher-quality medical care than individual practice associations? Ann Intern Med. 2006;145(11)826–833. Dec 5.

  31. 31.

    Li R, Simon J, Bodenheimer T, et al. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. Diabetes Care. 2004;27(10):2312–2316. Oct.

  32. 32.

    Institute of Medicine. Key Capabilities of an Electronic Health Record System. Washington, D.C.: National Academies Press; 2003.

  33. 33.

    Bodenheimer T, Wang MC, Rundall TG, et al. What are the facilitators and barriers in physician organizations’ use of care management processes? Jt Comm J Qual Saf. 2004;30(9):505–514. Sep.

  34. 34.

    Shortell SM, Marsteller JA, Lin M, et al. The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004;42(11):1040–1048. Nov.

  35. 35.

    Liang K, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

  36. 36.

    Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–130. Mar.

  37. 37.

    Schmittdiel J, McMenamin SB, Halpin HA, et al. The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations. Prev Med. 2004;39(5):1000–1006. Nov.

  38. 38.

    Rittenhouse DR, Casalino LP, Gillies RR, Shortell SM, Lau B. Measuring the medical home infrastructure in large medical groups. Health Aff. 2008;27(5):1246–1258. Sep–Oct.

  39. 39.

    Casalino LP, Devers KJ, Lake TK, Reed M, Stoddard JJ. Benefits of and barriers to large medical group practice in the United States. Arch Intern Med. 2003;163(16):1958–1964. Sep 8.

  40. 40.

    Burt CW, Sisk JE. Which physicians and practices are using electronic medical records? Health Aff. 2005;24(5):1334–1343. Sep–Oct.

  41. 41.

    Simon SR, Kaushal R, Cleary PD, et al. Physicians and electronic health records: a statewide survey. Arch Intern Med. 2007;167(5):507–512. Mar 12.

  42. 42.

    Donabedian A. Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly. 1966;44(3):166–203.

  43. 43.

    Bodenheimer T. Coordinating care-a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064–1071. March 6.

Download references

Acknowledgements

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

None disclosed.

Author information

Correspondence to Eric C. Schneider M.D., M.Sc..

Additional information

Financial support

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).

Prior presentations

Partial results from this paper were orally presented at the National Meeting of the Society of General Internal Medicine in Pittsburgh, PA, on April 12, 2008.

Electronic Supplementary Material

Below is the link to the electronic supplementary material

ESM 1 (DOC 110 KB )

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Friedberg, M.W., Safran, D.G., Coltin, K.L. et al. Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices. J GEN INTERN MED 24, 162–169 (2009). https://doi.org/10.1007/s11606-008-0856-x

Download citation

KEY WORDS

  • primary care
  • quality improvement
  • health policy
  • patient centered care