The Patient-Centered Medical Home and Patient Experience.
ABSTRACT OBJECTIVE: To examine the relationship between practices' reported use of patient-centered medical home (PCMH) processes and patients' perceptions of their care experience. DATA SOURCE: Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices. STUDY DESIGN: This is an observational, cross-sectional study. Using standard ordinary least-squares and a sample selection model, we estimated the association between patients' care experience and the use of PCMH processes in the practices where they receive care. DATA COLLECTION: We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices. PRINCIPAL FINDINGS: We found that practices' use of PCMH processes was not associated with patient experience after controlling for sample selection as well as practice and patient characteristics. CONCLUSIONS: In our study, which was large, but somewhat limited in its measures of the PCMH and of patient experience, we found no association between PCMH processes and patient experience. The continued accumulation of evidence related to the possibilities of the PCMH, how PCMH is measured, and how the impact of PCMH is gauged provides important information for health care decision makers.
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ABSTRACT: There is a well-established debate between Heckman sample selection and two-part models in health econometrics, particularly when no obvious exclusion restrictions are available. Most of this debate has focussed on the application of these models to health care expenditure. This paper revisits the debate in the context of female smoking and drinking, and evaluates the two approaches on three grounds: theoretical, practical and statistical. The two-part model is generally favoured but it is stressed that this comparison should be carried out on a case-by-case basis.Journal of Health Economics 04/2008; 27(2):300-7. · 1.60 Impact Factor
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ABSTRACT: The doctor-patient relationship has been eroded by many factors. Would e-mail enhance communication and address some of the barriers inherent to our medical practices? Of our study population, 4 physicians offered e-mail communication to participating patients and 4 did not. Both patients and physicians completed questionnaires regarding satisfaction, perceived quality, convenience, and promptness of the communication. Patient satisfaction significantly increased in the e-mail group compared with the control group in the areas of convenience (P < .0001) and the amount of time spent contacting their physician (P < .0001). Physician satisfaction in the e-mail group increased regarding convenience, amount of time spent on messages, and volume of messages. The response time was longer with e-mail. When asked if patients should be able to e-mail their physicians, most patients in the e-mail group and all but 2 of the physicians in the non-e-mail group responded "yes." E-mail communication was found to be a more convenient form of communication. Satisfaction by both patients and physicians improved in the e-mail group. The volume of messages and the time spent answering messages for the e-mail group physicians was not increased. E-mail has the potential to improve the doctor-patient relationship as a result of better communication.The Journal of the American Board of Family Practice / American Board of Family Practice 18(3):180-8.
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ABSTRACT: Lack of health insurance and a regular source of care (RSOC) are associated with suboptimal health care. This study examined the impact of a statewide program called the Community Healthcare Access Program (CHAP), which provided a RSOC for uninsured persons in Delaware. This cohort study used survey data to compare health care utilization from baseline to six months after enrollment in CHAP. The 795 eligible enrollees had significant increases in Pap tests, mammograms, breast exams, cholesterol tests, sigmoid/colonoscopy and influenza immunizations but not stool blood tests or pneumococcal immunizations. There was a significant decrease in the proportion with emergency department visits but not hospitalizations, and there was a significant improvement in satisfaction with care. Delaware's CHAP program is associated with significant improvements across many measures of health care utilization and represents a successful and financially feasible method for states to improve health care for their uninsured populations.Journal of Health Care for the Poor and Underserved 09/2005; 16(3):515-35. · 1.10 Impact Factor