Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites

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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Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites

10.21203/rs.3.rs-29190/v3 ◽

2020 ◽

Author(s):

Nathaniel Bell ◽

Rebecca Wilkerson ◽

Kathy Mayfield-Smith ◽

Ana Lòpez-De Fede

Keyword(s):

Community Health ◽

Performance Measures ◽

Medical Home ◽

Clinical Performance ◽

String Matching ◽

Approximate String Matching ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Matching Algorithm ◽

Medical Homes

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 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 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 reliable approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. The model also offers preliminary evidence of a stepwise increase in quality metrics once half of a CHC’s delivery sites become designated medical homes.

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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/v1 ◽

2020 ◽

Author(s):

Nathaniel Bell ◽

Rebecca Wilkerson ◽

Kathy Mayfield-Smith ◽

Ana Lòpez-De Fede

Keyword(s):

Community Health ◽

Medical Home ◽

String Matching ◽

Care Quality ◽

Approximate String Matching ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Quality Performance ◽

Clinical Quality ◽

The Impact

Abstract Background: Patient-Centered Medical Home (PCMH) adoption has been proposed 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 sites.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). All datasets were linked through geocoding and approximate string matching. Proportional implementation was assessed in 10% increments and regressed onto 14 clinical performance measures. The analysis included 1,281 community HCs and 8,022 delivery sites within the lower 48 states and District of Columbia.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 included in the analysis after removing false positive/negative matches managed at least 1 NCQA and/or JC designated site. There was no stepwise improvement in clinical quality across all 14 indicators as the proportion of designated delivery sites increased. A trend for numerous indicators was that site-level designation rates of at least 90% were associated with better indicator adherence.Conclusion: Geocoding and approximate string matching offers a more accurate approach to monitor the impact of PCMH transformation on meeting quality performance targets. The lack of a consistent stepwise association between increased site-level designation and clinical quality underscores the need for additional risk-adjustment criteria within annual quality performance reporting in order to assess whether PCMH interventions are improving patient care.

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Patient-Centered Medical Home Recognition and Clinical Performance in U.S. Community Health Centers

Health Services Research ◽

10.1111/1475-6773.12523 ◽

2016 ◽

Vol 52 (3) ◽

pp. 984-1004 ◽

Cited By ~ 33

Author(s):

Leiyu Shi ◽

De-Chih Lee ◽

Michelle Chung ◽

Hailun Liang ◽

Diana Lock ◽

...

Keyword(s):

Community Health ◽

Medical Home ◽

Community Health Centers ◽

Clinical Performance ◽

Health Centers ◽

Patient Centered Medical Home ◽

Patient Centered

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Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home

Translational Behavioral Medicine ◽

10.1007/s13142-015-0340-1 ◽

2015 ◽

Vol 5 (4) ◽

pp. 483-485 ◽

Cited By ~ 7

Author(s):

Denise M. Hynes ◽

◽

Joanna Buscemi ◽

Lisa M. Quintiliani

Keyword(s):

Behavioral Medicine ◽

Community Health ◽

Community Health Workers ◽

Medical Home ◽

Health Workers ◽

Position Statement ◽

Patient Centered Medical Home ◽

Patient Centered

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Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs

Medical Care Research and Review ◽

10.1177/1077558715618566 ◽

2016 ◽

Vol 73 (5) ◽

pp. 532-545 ◽

Cited By ~ 10

Author(s):

Meredith B. Rosenthal ◽

Shehnaz Alidina ◽

Mark W. Friedberg ◽

Sara J. Singer ◽

Diana Eastman ◽

...

Keyword(s):

Health Care ◽

Medical Home ◽

Health Care Quality ◽

Care Quality ◽

Patient Centered Medical Home ◽

Patient Centered

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The Role of the Patient-Centered Medical Home in Addressing Hepatitis B Perinatal Transmission: Charles B. Wang Community Health Center’s Hep B Moms Program

AAPI Nexus Policy Practice and Community ◽

10.17953/appc.12.1-2.u834q144071431h3 ◽

2014 ◽

Vol 12 (1-2) ◽

pp. 140-160

Author(s):

Isha Weerasinghe ◽

Nicole Bannister ◽

Vivian Huang ◽

Chari Cohen ◽

Jeffrey Caballero ◽

...

Keyword(s):

Hepatitis B ◽

Community Health ◽

Medical Home ◽

Perinatal Transmission ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Hep B

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Practice Leaders Report Targeting Several Types of Changes in Care Experienced by Patients During Patient-Centered Medical Home Transformation

Journal of Patient Experience ◽

10.1177/2374373520934231 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1509-1518

Author(s):

Denise D Quigley ◽

Nabeel Qureshi ◽

Luma Al- Masarweh ◽

Ron D Hays

Keyword(s):

Primary Care ◽

Health Education ◽

Patient Experience ◽

Medical Home ◽

Chronic Condition ◽

Care Management ◽

Care Quality ◽

Care Practice ◽

Patient Centered Medical Home ◽

Patient Centered

Patient-centered medical home (PCMH) has spurred primary care reform and improvements in patient care quality. Very little is known about the differences practices implement during PCMH transformation. We examined 105 primary care practice leader experiences during PCMH transformation, asking in semi-structured interviews about the changes they targeted. We used content analysis to classify these PCMH changes and examined how they aligned with what is measured on PCMH-recommended patient experience surveys. During PMCH transformation, practices most commonly targeted changes in care coordination (30%), access to care (25%), and provider communication (24%). Reported areas of PCMH transformation were measured by Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CAHPS), PCMH CAHPS, or supplemental CAHPS survey items, including team-based care (35%), providing more services on site (28%), care management (22%), patient-centered culture (18%), and chronic condition health education (13%). Many PCMH changes are captured by CAHPS patient experience items; some are not. For some uncaptured areas, patients are not the best source of information. To provide practice leaders information they need for PCMH transformation, CAHPS items need to measure care management to support medical and chronic conditions, and chronic condition health education.

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