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

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.

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

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.

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

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.

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

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.

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

2016 ◽  
Vol 52 (3) ◽  
pp. 984-1004 ◽  
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

Patient-Centered Care in a Medical Home

2011 ◽  
Vol 16 (2) ◽  
Author(s):  
Colette Carver ◽  
Anne Jessie
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Patient Centered Medical Homes ◽  
Medical Homes ◽  
Centered Care ◽  
Medical Home Model

There is general consensus that our current healthcare delivery system will not be able to supply an adequate workforce, contain costs, and meet the ever-increasing chronic-care needs of the growing and aging population in the United States (US). Some of the major challenges to the U.S. healthcare system are faced by those on the front lines, namely the healthcare workers in primary care. Part of the emerging solution for primary care is the adoption of the Patient-Centered Medical Home Model. The intent of this model is to provide coordinated and comprehensive care rooted in a strong collaborative relationship. Carilion Clinic in Southwestern Virginia is implementing this patient-centered model in which a proactive, multidisciplinary care team collectively takes responsibility for each patient. In this article we will elaborate on the concepts of patient-centered care and patient-centered medical homes, after which we will offer an exemplar describing the process that Carilion Clinic is using to establish patient-centered medical homes throughout their primary care departments. Limitations of the Patient-Centered Medical Home Model will also be discussed.

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

Medical Care ◽  
2015 ◽  
Vol 53 (5) ◽  
pp. 389-395 ◽  
Author(s):  
Leiyu Shi ◽  
Diana C. Lock ◽  
De-Chih Lee ◽  
Lydie A. Lebrun-Harris ◽  
Marshall H. Chin ◽  
...  
Keyword(s):  
Medical Home ◽  
Clinical Performance ◽  
Health Centers ◽  
Patient Centered Medical Home ◽  
Patient Centered

scholarly journals Teaching in a Patient-Centered Medical Home

2011 ◽  
Vol 20 (3) ◽  
pp. 163-165 ◽  
Author(s):  
Barbara A. Hotelling
Keyword(s):  
Maternity Care ◽  
Medical Home ◽  
Evidence Based ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Patient Centered Medical Homes ◽  
Medical Homes ◽  
The Right ◽  
Evidence Based Care ◽  
Family Centered

Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in their care with appropriate interventions and the right to informed consent and informed refusal.

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