Patient-centered medical home (PCMH) and clinical performance in community health centers

Introduction/Purpose: In recent years, support for the expansion of patient-centered medical homes (PCMH) model among primary care providers has widely increased. However, limited research has focused on PCMH adoption as well as its impact for safety-net providers that serve predominantly vulnerable populations. Community Health Centers (CHCs) are uniquely poised to successfully implement the PCMH model as they have proven to be effective in establishing comprehensive, accessible, and continuous primary care. This study aimed to assess the current status of PCMH model adoption in CHCs and evaluate the relationship between the extent of PCMH model adoption in CHCs and their clinical quality performance measures.

Methods: Data for this study came from Health Resources and Services Administration (HRSA)’s 2012 Uniform Data System (UDS) and HRSA’s internal survey of CHCs’ PCMH-recognition achievement. The dependent variables included 16 measures of clinical quality performance collected through UDS, including weight screening, aspirin therapy, asthma-related pharmacologic therapy, colorectal cancer screening, child immunization, child weight assessment, diabetes Control (HBA1c<7, 8, or 9), hypertension control, low birthweight, lipid therapy, pap test, prenatal care, tobacco cessation intervention, and tobacco assessment. Control variables included health center patient-, provider-, and facility characteristics. Descriptive analysis summarized the general patient-, provider-, and facility characteristics of CHCs included in this study. Bivariate analysis and multiple logistic regressions were conducted to compare clinical performance between CHCs with PCMH recognition versus those without.  

Findings: Nationally, about 25% CHCs received some sort of PCMH recognition. CHCs that receive PCMH-recognition generally perform better on clinical quality performance measures than CHCs that do not yet have PCMH recognition. PCMH-recognized CHCs were more likely to be ranked in the upper quartiles in clinical performance. After accounting for CHC patient-, provider-, and practice characteristics, CHCs with PCMH-recognition reported statistically significant better performance on such indicators as asthma-related pharmacologic therapy, diabetes control, hypertension control, pap test, prenatal care, and tobacco cessation intervention. CHCs with greater proportions of uninsured and minority patients benefited more from PCMH adoption as they reported higher levels of clinical quality performance on certain indicators than CHCs without PCMH adoption.

Conclusion: This study establishes the association between PCMH recognition and clinical quality performance among HRSA-supported CHCs. Our findings suggest that the PCMH model may serve as a strategy to further enhance quality of care in safety-net providers particularly for the uninsured and minority patients.