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

Lisa Kern, Rina Dhopeshwarker, Alison Edwards, Rainu Kaushal

Abstract


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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References


Davis, K., Schoen, C. & Stremikis, K. (2010). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally, 2010 update. (Accessed November 14, 2011, at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx.)

Patient-Centered Primary Care Collaborative. (Accessed November 14, 2011, at http://www.pcpcc.net/.)

National Committee for Quality Assurance. Patient-Centered Medical Home. (Accessed November 14, 2011, at www.ncqa.org/tabid/631/Default.aspx.)

Bitton, A., Martin, C. & Landon, B.E. (2010). A nationwide survey of patient centered medical home demonstration projects. Journal of General Internal Medicine 25 (6) 584-592.

Berenson, R.A. & Rich, E.C. (2010). US approaches to physician payment: the deconstruction of primary care. Journal of General Internal Medicine 25 (6) 613-618.

Berenson, R.A. & Rich, E.C. (2010). How to buy a medical home? Policy options and practical questions. Journal of General Internal Medicine 25 (6) 19-24.

Barr, M.S. (2008). The need to test the patient-centered medical home. Journal of the American Medical Association 300 (7) 834-835.

Jaen, C.R., Ferrer, R.L., Miller, W.L., Palmer, R.F., Wood, R., Davila, M., Stewart, E.E., Crabtree, B.F., Nutting, P.A. & Stange, K.C. (2010). Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project. Annals of Family Medicine 8 (Supplement 1) S57-67, S92.

Chen, P.W. (2010). Putting patients at the center of the medical home. New York Times. July 15, 2010. (Accessed November 14, 2011, at www.nytimes.com/2010/07/15/health/15chen.html.)

THINC: Taconic Health Information Network and Community. (Accessed November 14, 2011, at www.thincrhio.org.)

National Committee for Quality Assurance. Standards and guidelines for Physician Practice Connections - Patient-Centered Medical Home (PPC-PCMH). 2008. (Accessed November 14, 2011, at www.usafp.org/PCMH-Files/NCQA-Files/PCMH_Overview_Apr01.pdf.)

Taconic IPA. (Accessed November 14, 2011, at www.taconicipa.com.)

Browne, K., Roseman, D., Shaller, D. & Edgman-Levitan, S. (2010). Analysis & commentary. Measuring patient experience as a strategy for improving primary care. Health Affairs (Millwood) 29 (5) 921-925.

Agency for Healthcare Research and Quality. CAHPS: surveys and tools to advance patient-centered care. (Accessed November 14, 2011, at www.cahps.ahrq.gov/default.asp.)

Safran, D.G., Karp, M., Coltin, K., Chang, H., Li, A., Ogren, J. & Rogers, W.H. (2006). Measuring patients' experiences with individual primary care physicians. Results of a statewide demonstration project. J Journal of General Internal Medicine 21 (1) 13-21.

Beal, A.C., Doty, M.M., Hernandez, S.E., et al. (2006). Closing the divide: How medical home promote equity in health care: Results from the Commonwealth Fund 2006 health care quality survey. (Accessed November 14, 2011, at http://www.commonwealthfund.org/Publications/Fund-Reports/2007/Jun/Closing-the-Divide--How-Medical-Homes-Promote-Equity-in-Health-Care--Results-From-The-Commonwealth-F.aspx.)

Schoen, C., Osborn, R., Doty, M.M., Bishop, M., Peugh, J. & Murukutla, N. (2007). Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Affairs (Millwood) 26 (6) w717-734.

Agency for Healthcare Research and Quality. (2008). Clinician & Group Survey and Reporting Kit, 2008. (Accessed November 14, 2011, at http://www.cahps.ahrq.gov/surveys-guidance/cg/~/media/Files/SurveyDocuments/CG/12%20Month/Whats%20available/1031_cg_what_available.pdf.)

Agency for Healthcare Research and Quality. Compare Clinician & Group Survey Data. (Accessed November 14, 2011, at www.cahps.ahrq.gov/Surveys-Guidance/CG/Compare-CG-Survey-Data.aspx.)

Rodriguez, H.P., von Glahn, T., Chang, H., Rogers, W.H. & Safran, D.G. (2007). Patient samples for measuring primary care physician performance: who should be included? Medical Care 45 (10) 989-996.

Rodriguez, H.P., von Glahn, T., Chang, H., Rogers, W.H. & Safran, D.G. (2009). Measuring patients' experiences with individual specialist physicians and their practices. American Journal of Medical Quality 24 (1) 35-44.

Sequist, T.D., Schneider, E.C., Anastario, M., Odigie, E.G., Marshall, R., Rogers, W.H. & Safran, D.G. (2008). Quality monitoring of physicians: linking patients' experiences of care to clinical quality and outcomes. Journal of General Internal Medicine 23 (11) 1784-1790.

Rodriguez, H.P., Scoggins, J.F., von Glahn, T., Zaslavsky, A.M. & Safran, D.G. (2009). Attributing sources of variation in patients' experiences of ambulatory care. Medical Care 47 (8) 835-841.

Rodriguez, H.P., von Glahn, T., Rogers, W.H. & Safran, D.G. (2009). Organizational and market influences on physician performance on patient experience measures. Health Services Research 44 (3) 880-901.

Rodriguez, H.P., von Glahn, T., Elliott, M.N., Rogers, W.H. & Safran, D.G. (2009). The effect of performance-based financial incentives on improving patient care experiences: a statewide evaluation. Journal of General Internal Medicine 24 (12) 1281-1288.

Berwick, D.M. (2009). What 'patient-centered' should mean: confessions of an extremist. Health Affairs (Millwood) 28 (4) w555-565.

National Committee for Quality Assurance. NCQA's new distinction in patient experience reporting. (Accessed November 14, 2011, at http://www.ncqa.org/tabid/1429/Default.aspx.)




DOI: http://dx.doi.org/10.5750/ejpch.v1i2.662

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