Structural Capabilities in Small- and Medium- Sized Patient-Centered Medical Homes

Authors, Primary Alidina,Shehnaz;Schneider,Eric C.;Singer,Sara J.;Rosenthal,Meredith B.
Title Primary Structural Capabilities in Small- and Medium- Sized Patient-Centered Medical Homes
Periodical Full American Journal of Managed Care
Pub Year 2014
Volume 20
issue 9
Start Page Not Available
Abstract Objectives 1) Evaluate structural capabilities associated with the patient-centered medical home (PCMH) model in PCMH pilots in Colorado, Ohio, and Rhode Island; 2) evaluate changes in capabilities over 2 years in the Rhode Island pilot; and 3) evaluate facilitators and barriers to the adoption of capabilities. Study Design We assessed structural capabilities in the 30 pilot practices using a cross-sectional study design and examined changes over 2 years in 5 Rhode Island practices using a pre/post design. Methods We used National Committee for Quality Assurance's Physician Practice Connections-Patient-Centered Medical Home (PPC/PCMH) accreditation survey data to measure capabilities. We stratified by high and low performance based on total score and by practice size. We analyzed change from baseline to 24 months for the Rhode Island practices. We analyzed qualitative data from interviews with practice leaders to identify facilitators and barriers to building capabilities. Results On average, practices scored 73 points (out of 100 points) for structural capabilities. High and low performers differed most on electronic prescribing, patient self-management, and care-management standards. Rhode Island practices averaged 42 points at baseline, and reached 90 points by the end of year 2. Some of the key facilitators that emerged were payment incentives, "transformation coaches," learning collaboratives, and data availability supporting performance management and quality improvement. Barriers to improvement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform. Conclusions For these early adopters, prevalence of structural capabilities was high, and performance was substantially improved for practices with initially lower capabilities. We conclude that building capabilities requires payment reform, attention to implementation, and cultural change.
Publisher Intellisphere, LLC
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;Demonstrations;Outcomes;Implementation
Special Population(s) Not Available
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
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