Patient experience at the time of practice transformation into Patient-Centered Medical Homes

Purpose: The Patient-Centered Medical Home (PCMH) is a model of primary care that is being promoted for its potential ability to improve patient-centeredness, improve quality and decrease costs. The effect of the PCMH on patient experience is not clear, with some reports suggesting that patient experience may worsen during transformation. We sought to measure patient experience at the time practices transform into PCMHs.Methods: We conducted a cross-sectional survey of 419 adult patients who were cared for by 85 primary care physicians across 12 practices in the Hudson Valley region of New York State. We measured patient experience, using the 35 questions in the Clinician & Group – Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) – Adult Primary Care Questionnnaire (plus 14 additional questions drawn from other survey instruments) and compared the results to national CG-CAHPS benchmarks.Results: Patients’ experience overall was fairly positive, with 79% giving their doctors a ranking of 9 or 10 on a 10-point scale, with 10 being the highest. Patients’ experience in this sample was significantly more positive than the national benchmark on each of 6 subscales (p ≤ 0.05). Patients were generally most satisfied with individual face-to-face encounters with their physicians and somewhat less satisfied with processes of care (such as receiving results from a test or receiving follow-up after discharge from the hospital).Conclusions: This study suggests that medical home transformation does not adversely impact patient experience and identifies organizational processes of care that could potentially be improved with the patient-centered medical home.

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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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Is Access to and Use of Primary Care Practices that Patients Perceive as Having Essential Qualities of a Patient-Centered Medical Home Associated With Positive Patient Experience? Empirical Evidence From a U.S. Nationally Representative Sample

Journal for Healthcare Quality ◽

10.1097/01.jhq.0000462688.01125.c2 ◽

2017 ◽

Vol 39 (1) ◽

pp. 4-14 ◽

Cited By ~ 2

Author(s):

Haichang Xin ◽

Meredith L. Kilgore ◽

Bisakha (Pia) Sen

Keyword(s):

Primary Care ◽

Empirical Evidence ◽

Patient Experience ◽

Medical Home ◽

Representative Sample ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Care Practices ◽

Nationally Representative ◽

Primary Care Practices

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Faculty Opinions recommendation of Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1157385.617540 ◽

2009 ◽

Author(s):

Stewart Babbott

Keyword(s):

Primary Care ◽

Medical Home ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Care Practices ◽

Primary Care Practices

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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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