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Patient-centered Medical Home capability and clinical performance in HRSA-supported health centers
Leiyu Shi1, Diana C Lock, De-Chih Lee
1*Primary Care Policy Center, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD †Department of Information Management, Da-Yeh University, Changhua, Taiwan, Republic of China ‡Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD §University of Chicago Medicine, Chicago, IL ∥Office of Quality and Data, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD.
Objectives:
To evaluate the relationship between Patient-centered Medical Home (PCMH) model adoption in health centers (HCs) and clinical performance measures and to determine if adoption of PCMH characteristics is associated with better clinical performance.
Research Design:
Data came from the Health Resources and Services Administration's 2009 Uniform Data System and the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. Clinical performance measures included 2 process measures (childhood immunization and cervical cancer screening) and 2 outcome measures (hypertension control and diabetes control). Total and subscale PCMH scores were regressed on the clinical performance measures, adjusting for patient, provider, financial, and institutional characteristics.
Results:
The findings showed different directional relationships, with some PCMH domains (care management, test/referral tracking, quality improvement, and external coordination) showing little or no effect on outcome measures of interest, 1 domain (access/communication) associated with improved outcomes, and 1 domain (patient tracking/registry) associated with worse outcomes.
Conclusions:
This study is among the first to examine the association between PCMH transformation and clinical performance in HCs, providing an understanding of the impact of PCMH adoption within safety-net settings. The mixed results highlight the importance of examining relationships between specific PCMH domains and specific clinical quality measures, in addition to analyzing overall PCMH scores which could yield distorted findings.
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