Reaching Beyond Patient-Centered Medical Home Walls: A Mixed-Methods Evaluation of A Community Health Team Intervention

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/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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