PCMH transformation among small urban primary care practices serving the underserved

Objective: The Primary Care Information Project (PCIP) is a program administered by the New York City Department of Health and Mental Hygiene to improve population health by assisting primary care providers (PCPs) transform their practices into patient centered medical homes (PCMH). The objectives of this study are to determine how PCIP affected change in practice management, health care processes and patient care and to determine what associations exist among these measures.

Methods: This retrospective evaluation utilizes a mixed methods approach, including electronic health record (EHR) and Medicaid claims data, a comprehensive provider survey, site visits, and key informant interviews with physicians and patients.

Population: The study focuses on small practices with fewer than 5 providers and with high volumes of patients who are enrolled in Medicaid or who have no insurance converage. The sample was limited to practices that have: (1) implemented an EHR with the potential to meet NCQA Level 1 PCMH recognition as of 2009 and (2) received at least two visits from a PCIP Quality Improvement Specialist. The final sample size is 156 practices that have been participating in the PCIP program for at least 2 years. Our sample consists of 265 providers, with an average of 1.8 (1 – 5) providers per practice. Each practice serves an average of 3,425 (22 – 9,851) active patients and 50 of the practices have received PCMH recognition.

Findings: Research is ongoing; however, findings will include both intermediate and final outcomes. Practice management indicators include: (1) the extent to which decision support alerts and reminders were activated and responded to; (2) the frequency of lab data imported into the EHR and reviewed by the PCP; (3) the extent to which patient problem lists have been implemented and edited; (4) patient scheduling data including follow-up calls and reschedules of missed appointments. Health care process and patient health measures include optimal chronic care and preventive care indicators.

Conclusions: Efforts to help practices transform to PCMH are expensive and labor intensive and there is a need for empirical evidence to show that it will actually result in improved care processes and patient outcomes. Findings from this study will demonstrate what relationships exists among elements of PCMH, quality of health care and patient health outcomes, and whether departments of health and health plans should be relying on it as a panacea for improvement.