The Patient-Centered Medical Home and Patient Experience

Department of Health Policy and Administration, Pennsylvania State University, 610 N Euclid Ave, Pittsburgh, PA, 15206.
Health Services Research (Impact Factor: 2.78). 06/2012; 47(6). DOI: 10.1111/j.1475-6773.2012.01429.x
Source: PubMed


To examine the relationship between practices' reported use of patient-centered medical home (PCMH) processes and patients' perceptions of their care experience.
Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices.
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.
We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices.
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.
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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Available from: Dennis Scanlon, May 07, 2015
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    ABSTRACT: Improving the patient experience of primary care is a stated focus of efforts to transform primary care practices into "Patient-centered Medical Homes" (PCMH) in the United States, yet understanding and promoting what defines a positive experience from the patient's perspective has been de-emphasized relative to the development of technological and communication infrastructure at the PCMH. The objective of this qualitative study was to compare primary care clinicians' and their patients' perceptions of the patients' experiences, expectations and preferences as they try to achieve care for depression. We interviewed 6 primary care clinicians along with 30 of their patients with a history of depressive disorder attending 4 small to medium-sized primary care practices from rural and urban settings. Three processes on the way to satisfactory depression care emerged: 1. a journey, often from fractured to connected care; 2. a search for a personal understanding of their depression; 3. creation of unique therapeutic spaces for treating current depression and preventing future episodes. Relative to patients' observations regarding stigma's effects on accepting a depression diagnosis and seeking treatment, clinicians tended to underestimate the presence and effects of stigma. Patients preferred clinicians who were empathetic listeners, while clinicians worried that discussing depression could open "Pandora's box" of lengthy discussions and set them irrecoverably behind in their clinic schedules. Clinicians and patients agreed that somatic manifestations of mental distress impeded the patients' ability to understand their suffering as depression. Clinicians reported supporting several treatment modalities beyond guideline-based approaches for depression, yet also displayed surface-level understanding of the often multifaceted support webs their patient described. Improving processes and outcomes in primary care may demand heightened ability to understand and measure the patients' experiences, expectations and preferences as they receive primary care. Future research would investigate a potential mismatch between clinicians' and patients' perceptions of the effects of stigma on achieving care for depression, and on whether time spent discussing depression during the clinical visit improves outcomes. Improving care and outcomes for chronic disorders such as depression may require primary care clinicians to understand and support their patients' unique 'therapeutic spaces.'
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    ABSTRACT: BACKGROUND:: The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience. OBJECTIVE:: To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience. RESEARCH DESIGN:: Multilevel cross-sectional analysis of patients nested within the primary care clinics that serve them. SUBJECTS:: Primary care clinic leaders and patients throughout the City of New Orleans health care safety-net. MEASURES:: Dependent variables included patient ratings of accessibility, coordination, and confidence in the quality/safety of care. The key independent variable was a score measuring PCMH structural and process improvements at the clinic level. RESULTS:: Approximately two thirds of patients in New Orleans gave positive ratings to their clinics on access and quality/safety, but only one third did for care coordination. In all but the largest clinics, patient experiences of care coordination were positively associated with the clinic's use of PCMH structural and process changes. Results for patient ratings of access and quality/safety were mixed. CONCLUSIONS:: Among primary care clinics in the New Orleans safety-net, use of more PCMH improvements at the clinic level led to more positive patient rating of care coordination, but not of accessibility or confidence in quality/safety. Ongoing efforts to pilot, demonstrate, implement, and evaluate the PCMH should consider how the impact of medical practice transformation could vary across different aspects of the patient experience.
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