263245 Assessing transformation toward medical homeness: The Massachusetts patient-centered medical home initiative demonstration

Monday, October 29, 2012 : 5:10 PM - 5:30 PM

Judith Savageau, MPH , Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Teresa Anderson, PhD , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Bruce Barton, PhD , Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1. Participants will be able to describe the key features of a patient-centered medical home demonstration project at the statewide level in order to apply these principles to future PMCH efforts in their own community. 2. Participants will be able to discuss the mixed-methods strategies used in this demonstration project to assess medical homeness of primary care practices, including community health centers. 3. Participants will be able to compare different interventions used to assist practices in their PCMH initiatives and what components of the MHIQ score are most notable as needing additional efforts to reach practicesí PCMH goals.

Keywords: Primary Care, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have participated in the work described in the Abstract and have worked collegially on this project with other members of the presentation team.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.