Patient-centered Medical Home Capability and Clinical Performance in HRSA-supported Health Centers

Abstract Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. Results The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. Conclusion Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved.

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Association of Patient-Centered Medical Home Designation and Quality Indicators within HRSA-Funded Community Health Center Delivery Sites

10.21203/rs.3.rs-29190/v2 ◽

2020 ◽

Author(s):

Nathaniel Bell ◽

Rebecca Wilkerson ◽

Kathy Mayfield-Smith ◽

Ana Lòpez-De Fede

Keyword(s):

Performance Measures ◽

Medical Home ◽

Clinical Performance ◽

String Matching ◽

Care Quality ◽

Approximate String Matching ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Matching Algorithm ◽

Medical Homes

Abstract Background: Patient-Centered Medical Home (PCMH) adoption is as an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) Community Health Centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes.Methods: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation.using 10% increments in site designation and regressed onto 11 clinical performance measures using beta logistic regression.Results: The geocoding and approximate string matching algorithm identified 2,615 of the 6,851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n=777) of the 1,039 CHCs that met the inclusion criteria for the analysis managed at least 1 NCQA and/or JC designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHC’s that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9% to 11.8% improvement, depending on the measureConclusion: Geocoding and approximate string matching techniques offer a more nuanced approach for addressing ongoing limitations in HRSA’s PCMH evaluations. The study methodology proposes new questions to as to whether there is a threshold effect when measuring the association between designation and care quality. The model also offers preliminary evidence of a step-wise increase in quality metrics once half of a CHCs delivery sites become designated medical homes.

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