Is Residency Program Size Correlated with Quality Performance within the New York State Hospital Medical Home Demonstration?
background: Over 150 teaching-hospital OPD sites participated in the CMS-funded HMH demonstration (operated by the New York State Department of Health (NYS DOH) from 2013-2014) to convert OPD sites to medical homes, recognized by the National Committee of Quality Assurance, and teach medical home concepts to residents. Sites were required to submit quarterly data for care coordination, continuity, and quality measures. This research tests the hypothesis that having a larger residency program is correlated with higher performance rates for the following measures: rate of resident continuity with their own patient panel, rate of prescriptions written in the preferred language of the patient, rate of timely transmission of transition records from the hospital to the OPD, rate of follow-up visits for high-risk patients with their assigned resident at the OPD within 48 hours of discharge, rate of readmissions within 30 days of the initial admission, and rate of patients at the OPD with documentation of a medication reconciliation upon admission. Residency program sizes range from six to 408 residents.
methods: A Pearson’s correlation test was performed to determine whether the size of participating residency clinics was correlated with desirable rates of each measure. An alpha value of .05 was used to determine statistical significance. Reported rates from Q3 2014 were used in the analysis and will be repeated when Q4 2014 data is available. Residency program size was reported at the beginning of the demonstration.
results: There was no significant correlation between residency size and greater continuity with resident’s own patient panel (correlation=.11, p=.21) or follow-up visits within 48 hours of hospital discharge (correlation=.13, p=.27). A significant positive correlation was observed for prescriptions written in the preferred language of the patient (correlation=.86, p<.0001), timely transmission of transition records from the hospital to the OPD (correlation=.43, p=.0002), and medication reconciliation upon admission (correlation=.39, p=.0005). A significant negative correlation was observed for readmissions (correlation=-.24, p=.04) showing that larger residency programs had fewer readmissions.
conclusions: For three of the six measures, residency size was positively correlated with performance. There was a negative correlation between residency size and readmissions. Further research will be conducted to assess if other factors are correlated with improved coordination, continuity, and quality of care in OPDs.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Identify whether or not correlations exist between specific care coordination measures and residency program size of hospital outpatient department sites participating in the New York Hospital Medical Home demonstration. Evaluate whether or not residency program size has an effect on specific care coordination project measures.
Keyword(s): Patient-Centered Care, Health Systems Transformation
Qualified on the content I am responsible for because: I have been a data analyst for the hospital medical home demonstration since October 2013 evaluting succeses and challenges of hospital sites throughout the course of the demonstration, performing correlation analyses between measures and program factors, and evaluating project outcomes.
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.