Development of a Safety Net Medical Home Scale for Clinics

Authors, Primary Birnberg,Jonathan M.;Drum,Melinda L.;Huang,Elbert S.;Casalino,Lawrence P.;Lewis,Sarah E.;Vable,Anusha M.;Tang,Hui;Quinn,Michael T.;Burnet,Deborah L.;Summerfelt,Thomas;Chin,Marshall H.
Title Primary Development of a Safety Net Medical Home Scale for Clinics
Periodical Full Journal of General Internal Medicine
Pub Year 2011
Volume 26
issue 12
Start Page 1418-25
Abstract Background: Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics. Objective: Develop a scale to measure PCMH adoption in safety-net clinic. Research Design: Cross-sectional survey. Subjects: Sixty-five clinics in five states. Main Measures: Fifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0-100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption. Results: The SNMHS had high internal consistency reliability (Cronbach's alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r =0.64, p < 0.0001) and the PCMH-A (r = 0.56, p <0.001). The mean SNMHS score was 61 +-SD 13. Among the subscales, External Coordination (66 +-16) and Access and Communication (65 +- 14) had the highest mean scores, while Quality Improvement (55 +- 17) and Care Management (55 +-16) had lower mean scores. Clinic characteristics positively associated with total SNMHS score were having more providers (B 15.8 95% CI 8.1-23.4 >8 provider FTEs compared to <4 FTEs) and participation in financial incentive programs (B 8.4 95% 1.6-15.3). Conclusion: The SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.
Publisher Not Available
Place of Publication Not Available
Author/Address Not Available
PubMed Link
Reference Type(s) Journal Article
Topic Tag(s) Defining/Evaluating/Qualifying a Medical Home;Evaluation Methods and Approaches;Implementation
Special Population(s) Not Available
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
Article Rating No
Summary of Article Rating No