Association of clinic-level characteristics with patient-centered care experience

Introduction: Patient-centered innovations are being implemented in medical practices nationally. No studies have explored whether clinic-level innovation or clinic characteristics that are amenable to change improve patient experience scores of medical home domains. Methods: We assessed clinic-level characteristics and surveyed patients (n=1,035) at eight clinics to measure patient experiences with domains of a patient-centered medical home (PCMH). Clinics were categorized as innovator or comparison based on a priori informed judgment of an executive of the provider organization. We used a mixed effect, maximum likelihood regression model clustered by clinics to measure the association between clinic characteristics and patient-reported experience on domains of a PCMH. Model covariates were patient-level demographic characteristics. Results: Patients receiving care in innovator clinics scored their access to care as 0.16 units better (95% CI:0.001-0.53, p-value=0.044), and the overall patient-centeredness of their care as 0.27 unit greater (95% CI:0.05-0.26, p-value=0.005), than those who received care in a comparison clinic, after controlling for all other covariates. Patients receiving care at clinics with the ability to generate patient lists by diagnosis and provider had greater scores in access to care (0.22, 95% CI:0.08-0.36, p-value<0.001), care coordination (0.32, 95% CI:0.01-0.64), global rating of care (0.83, 95% CI:0.44-1.21), and medical home composite score (0.50, 95% CI:0.08-0.93) compared to patients receiving care from clinics unable to generate such lists, controlling for covariates. Conclusions: Patients receiving care in clinics demonstrating innovations of patient-centered care may result in greater experiences with domains of a patient-centered medical home.