Enhanced primary care and impact on quality of care in Massachusetts

Using Behavioral Risk Factor Surveillance System (BRFSS) telephone survey data, we evaluated whether individuals who reported access to enhanced primary care features experienced improved quality of care.

Cross-sectional population-level survey.

We assessed a sample of 16,731 Massachusetts residents contacted by telephone using random-digit dialing, to complete the BRFSS in 2008. A randomized subset of 5693 respondents received an additional 5-question enhanced primary care assessment module. We defined an "enhanced" primary care group as those who reported having a regular, personal provider and responded that their provider "always" or "almost always" 1) had knowledge of their medical history, 2) gave them an appointment right away when necessary, 3) was up-to-date in their knowledge of the patient's specialist care, and 4) asked them about all of their medications. Multivariable logistic regression was used to compare the "enhanced" versus "usual care" groups and assess several quality process measures.

Nearly one-third of participants endorsed having indicators of enhanced care, and this group reported significantly higher rates of diabetes process measures (56% vs 38%), cholesterol screening (89% vs 81%), influenza vaccination (57% vs 49%), pneumonia vaccination (51% vs 43%), and lower cost and/or access barriers to care (22% vs 33%).

Enhanced primary care was associated with improved self-reported quality outcomes in a statewide telephone survey. A brief, 5-question module provided a novel population measure of access to enhanced primary care. This is a scalable option for other states hoping to characterize their own primary care improvement efforts through the patient-centered medical home model.