Adoption of the medical home in Connecticut

To examine the implementation of key features of the medical home concept, with its emphasis on chronic care and disease management, care coordination, case management and timely access to care in Connecticut primary-care practices, and to examine predictors of its implementation in Connecticut.

Primary care physicians affiliated with the Connecticut Chapter of the American College of Physicians (n = 1088), the Connecticut Chapter of the American Academy of Pediatrics (n = 699), and the Connecticut Academy of Family Physicians (n = 376) were invited to participate in a brief online survey. Participation was limited to physicians who were actively engaged in primary-care medicine as determined by the respondent based on information provided as part of the survey.

Four hundred ninty-eight primary-care physicians practicing in Connecticut completed the survey resulting in an overall response rate of 23%. In general, many of the core components of the medical home concept were not widely implemented yet in Connecticut. Most common were registries of patients with chronic diseases (33% of sample) and open or advanced access scheduling (57% of sample). Electronic medical records (EMR) systems were currently used by 39% of primary care physicians. Substantial differences by specialty were observed, with chronic disease registries and advanced/open access scheduling significantly less common among internists, and EMR systems significantly less common among pediatricians. The only factor consistently associated with increased likelihood of implementing the medical home concept was larger practice size (number of practicing physicians within the medical practice). Open or advanced access scheduling resulted in significantly shorter appointment wait times for patients.

These results reveal that the adoption of the medical home model among Connecticut primary-care physicians remains in its infancy and suggests possible approaches to removing barriers to the implementation of the medical home model in Connecticut.