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

BMC Health Services Research ◽

10.1186/s12913-020-05826-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nathaniel Bell ◽

Rebecca Wilkerson ◽

Kathy Mayfield-Smith ◽

Ana Lòpez-De Fede

Keyword(s):

Community Health ◽

Medical Home ◽

Clinical Performance ◽

String Matching ◽

Care Quality ◽

Approximate String Matching ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Matching Algorithm ◽

Matching Techniques

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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The Impact of Integrating Community Health Workers Into the Patient-Centered Medical Home

Journal of Primary Care & Community Health ◽

10.1177/2150131914540694 ◽

2014 ◽

Vol 5 (4) ◽

pp. 271-274 ◽

Cited By ~ 15

Author(s):

Luz Adriana Matiz ◽

Patricia J. Peretz ◽

Patricia G. Jacotin ◽

Carmen Cruz ◽

Erline Ramirez-Diaz ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Medical Home ◽

Health Workers ◽

Patient Centered Medical Home ◽

Patient Centered ◽

The Impact

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Assessing the relationship between adoption of the patient-centered medical home model and clinical quality in Missouri's federally qualified health centers||Assessing the relationship between adoption of the patient-centered medical home model and clinical quality in Missouri's federally qualified health centers

10.32469/10355/44349 ◽

2014 ◽

Author(s):

Phillip Berger

Keyword(s):

Medical Home ◽

Health Centers ◽

Patient Centered Medical Home ◽

Federally Qualified Health Centers ◽

Patient Centered ◽

Clinical Quality ◽

Medical Home Model ◽

The Relationship

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Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00597.1 ◽

2015 ◽

Vol 7 (4) ◽

pp. 580-588 ◽

Cited By ~ 4

Author(s):

Fadya El Rayess ◽

Roberta Goldman ◽

Christopher Furey ◽

Rabin Chandran ◽

Arnold R. Goldberg ◽

...

Keyword(s):

Primary Care ◽

Situated Learning ◽

Medical Home ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Individual Interviews ◽

Knowledge And Attitudes ◽

Positive Attitudes ◽

Level 3 ◽

The Impact

ABSTRACT Background The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Brown University achieved Level 3 PCMH accreditation in 2010, with training relying primarily on situated learning through immersion in PCMH practice, supplemented by didactics and a few focused clinical activities. Objective To assess PCMH knowledge and attitudes after Level 3 PCMH accreditation and to identify additional educational needs. Methods We used a qualitative approach, with semistructured, individual interviews with 12 of the program's 13 postgraduate year 3 residents and 17 of 19 core faculty. Questions assessed PCMH knowledge, attitudes, and preparedness for practicing, teaching, and leading within a PCMH. Interviews were analyzed using the immersion/crystallization method. Results Residents and faculty generally had positive attitudes toward PCMH. However, many expressed concerns that they lacked specific PCMH knowledge, and felt inadequately prepared to implement PCMH principles into their future practice or teaching. Some exceptions were faculty and resident leaders who were actively involved in the PCMH transformation. Barriers included lack of time and central roles in PCMH activities. Conclusions Practicing in a certified PCMH training program, with passive PCMH roles and supplemental didactics, appears inadequate in preparing residents and faculty for practice or teaching in a PCMH. Purposeful curricular design and evaluation, with faculty development, may be needed to prepare the future leaders of primary care.

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