Assessing transformation toward medical homeness: The Massachusetts patient-centered medical home initiative demonstration

Background: The Massachusetts Executive Office of Health and Human Services (EOHHS) developed the Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) in 2009. This initiative's purpose is to sustain Massachusetts' health reform via a public/private cooperative effort to promote adoption of the medical home model for quality, enhanced primary care. The Center for Health Policy and Research at UMass Medical School was charged with evaluating the multi-payer PCMHI's efforts which involve all major Massachusetts commercial and Medicaid payers, and a diverse group of statewide primary care practices. The full evaluation seeks to measure select outcomes, including: mastery of PCMH core competencies; improvements in patient experiences; and select clinical outcomes - relative to non-participating practices. The primary research question of this project included to what extent and how do practices become medical homes.

Methods: Using an exploratory sequential mixed-methods design, Medical Home Implementation Quotient (MHIQ) results collected from 46 primary care practices (100% responding) were reviewed with qualitative analyses of document reviews, focus groups and interviews. Frequency statistics along with factor analyses were conducted to investigate the MHIQ domains. Qualitative results were compared to these analyses' results. Linear regression models for each of the nine MHIQ modules were also fit to assess the influence of practice characteristics on the overall MHIQ score.

Results: The nine MHIQ elements include for example, Access to Care and Information, Quality and Safety, Health Information Technology, Practice-based Services, and Practice-based Care Teams. Summary scores (as a percent of possible maximum) for each MHIQ module ranged from a low of 37% for Access to Care and Information to a high of 79% for Practice-based Services. Other than Access, all other elements scored between 65% and 79%. Factors identified to better understand the underlying structure of Access included scheduling visits/appointments, communication, and handling requests for urgent/prompt care. The initial regression analysis of the Access module found that ownership had a significant impact on the MHIQ score; practices associated with a hospital or health system had a higher mean Access scores compared to physician-owned or non-profit practice types. Qualitative results suggest that the high scoring practices had both an EMR and sufficient staff resources to consistently promote enhanced access. Conclusions: There was substantial variation across practices in each MHIQ baseline score, with practice ownership determined to be the most important predictor of the baseline Access score. Qualitative results suggested areas for promoting access. The presentation will present all MHIQ module analyses.