Adoption of Medical Home Characteristics: Interim Results from the Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI)

Research Objective In the MA PCMHI, a state-wide, three-year multi-payer demonstration of patient centered medical home implementation, we collected quantitative data at pre-intervention and at the mid-point of the project using the Medical Home Implementation Quotient (MHIQ) from TransforMED. Our objectives were: to evaluate the progress toward adoption of medical home characteristics using the change in the scores from the nine MHIQ modules; and to identify any differences in that progress by level of intervention.

Study design Sixty-four medical practices were allocated to levels of intervention: Technical Assistance plus financial support (TA-Pay) group, Technical assistance only (TA Only) group, and Comparison group without any intervention. Three staff members from each practice completed the MHIQ at each time point. We conducted an ANOVA analysis for each module and the total score with time (baseline, mid-point) and level of intervention (TA-Pay, TA Only, Comparison) as the predictors.

Population studied Medical practices in Massachusetts selected for this demonstration project.

Principal Findings ANOVA analysis of change in the nine MHIQ module scores (plus the overall total score) from the Baseline to the Mid-Point data collection showed that five modules (Access to Care and Information, Patient-Centered Care, Practice-Based Care Team, Care Coordination, and Care Management) showed a significant increases (p less than 0.05) in the scores across the three intervention groups, indicating movement toward medical homeness among the groups. Two more (Practice-Based Services and the overall total score) showed non-significant trends toward higher scores (both p equal 0.06). The remaining three modules (Practice Management, Quality and Safety, and Health Information Technology) showed no significant trend in either direction (all p greater than 0.10). Interestingly, there were no significant differences in the changes among the intervention groups for any module or the total score, tested using interaction terms.

Conclusions Analysis indicates significant movement toward medical home characteristics in several areas measured by the MHIQ, but that movement was similar for all intervention levels.

Implications for Policy, Delivery, or Practice Implementations of new service models in natural settings are subject to a range of unrelated changes in public policy and private payment arrangements, including incentives for all medical practices to move in this direction, and practice differences may take longer to emerge, becoming evident over the final months of the initiative. Demonstrations such as the MA PCMHI often lack sufficient statistical power and long enough follow-up to detect small or moderate intervention effects.