141st APHA Annual Meeting

In This section

284197
Patient centered medical home recognition and key dimensions of PCMH among small, urban, high volume Medicaid practices

Tuesday, November 5, 2013 : 11:00 AM - 11:15 AM

Margaret Paul, MS , Department of Population Health, NYU School of Medicine, New York, NY
Carolyn Berry, PhD , NYU School of Medicine, New York, NY
Tod Mijanovich, PhD , Steinhardt School of Culture, Education and Public Health, New York University, New York, NY
Stephanie Albert, MPA , NYU School of Medicine, New York, NY
Sarah Shih, MPH , Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, NY
Mandy Smith Ryan, PhD , Primary Care Information Project (PCIP), Division of Healthcare Access and Improvement, NYC Department of Health and Mental Hygiene, Long Island City (Queens), NY
Chloe Winther, BA , Primary Care Information Project (PCIP), Division of Healthcare Access and Improvement, NYC Department of Health and Mental Hygiene, Long Island City (Queens), NY
Objective: The Primary Care Information Project (PCIP) is a program administered by the New York City Department of Health and Mental Hygiene to assist primary care providers adopt a fully-functional electronic health record (EHR) and focus more on population health. One of the auxiliary services provided by PCIP is to provide assistance to pursue Patient Centered Medical Home (PCMH) recognition by the National Committee for Quality Assurance (NCQA). The objectives of this study are to determine how formal PCMH recognition by the National Committee for Quality Assurance (NCQA) is related to the presence of key dimensions of PCMH among PCIP practices and to describe potential barriers to achieving recognition.

Methods: This analysis relied on data collected from a comprehensive practice assessment survey of PCIP practices. The survey was developed to assess the dimensions of PCMH model implementation proposed by Rittenhouse et al., including: 1) each patient has a personal physician; 2) whole person orientation; 3) team-based care; 4) coordination and integration of care across the health system; 5) a focus on quality and safety; and 6) timely access to care and communication. The survey also included content about other practice characteristics, including details of application/award status of PCMH recognition by NCQA.

Population: The study population includes practices for which survey results are available among PCIP practices with fewer than 5 providers and high volumes of patients who are enrolled in Medicaid or who have no insurance converage (64% response rate; n = 94).

Findings: At the time of survey, 40% of practices had received some level of NCQA recognition (n = 38) and these practices were significantly more likely to have care teams in place relative to those without recognition (92% and 64%, respectively; p = 0.002). However, NCQA status was not significantly associated with many other characteristics associated with PCMH, including but not limited to: 1) use of care managers; 2) patients see the same provider; 3) staff meet to review care plans; 4) provider availability on evenings/weekends; 5) e-prescribing; or 6) systematically monitoring patients with chronic illness. The most common self-reported barrier to applying for NCQA recognition among those who had not applied (n = 58) was that they did not know enough about PCMH (30%).

Conclusions: This discrepancy between NCQA recognition and presence of key PCMH components suggests formal recognition mechanisms may not adequately capture PCMH in the small practice environment.

Learning Areas:
Public health or related public policy

Learning Objectives:
Describe how formal PCMH recognition by the National Committee for Quality Assurance (NCQA) is related to the presence of key dimensions of PCMH among PCIP practices Describe potential barriers to achieving recognition among our sample of practices

Keywords: Primary Care, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral candidate in the public health program at NYU and am working as a graduate research assistant at the NYU school of medicine on a range of evaluation projects, mostly related to PCMH implementation and impact evaluation. My background includes experience with the qualitative and quantitative methodologies commonly associated with program evaluation, including those used in this study.
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.