Hall Allyson G, Webb Fern J, Scuderi Christopher B, Tamayo-Friedel Claudia, Harman Jeffrey S
University of Florida, Gainesville, FL, USA
University of Florida, Jacksonville, FL, USA.
J Prim Care Community Health. 2014 Oct;5(4):247-52. doi: 10.1177/2150131914538455. Epub 2014 Jun 13.
There is growing and sustained recognition that Patient-Centered Medical Homes (PCMHs) represent a viable approach to dealing with the fragmentation of care faced by many individuals, including those living with diabetes. The National Committee for Quality Assurance (NCQA) has spearheaded a program that recognizes medical practices that adopt key elements of the PCMH. Even though practices can achieve the same level of recognition, it is unclear whether all PCMHs deliver care in the same manner and how these differences can be associated with patient ratings of their experience with care.
This study uses a mixed-methods approach to explore differences in care delivery across 4 NCQA level 3 recognized PCMHs located in a southern state. Furthermore, the study examines the association between each clinic and patient ratings of key PCMH domains. The qualitative component of the study included in-depth interviews with medical directors at each site in order to determine how the PCMH at each clinic was operationalized. In addition, 1300 adult patients with diabetes were surveyed about their experiences with their PCMH. Bivariate and ordinal logistical analyses were conducted to determine how PCMH experiences varied across the 4 clinics.
The in-depth interviews revealed that one clinic (clinic 1) had a stronger primary care orientation relative to the other locations. Furthermore, patients at these clinics were more likely to provide higher ratings of care across all PCMH domains.
This study demonstrates that not all PCMH clinics are alike and that these differences can possibly affect patient perceptions of their care.
越来越多的人持续认识到，以患者为中心的医疗之家（PCMH）是应对包括糖尿病患者在内的许多人所面临的医疗碎片化问题的一种可行方法。美国国家质量保证委员会（NCQA）率先开展了一项计划，认可采用PCMH关键要素的医疗实践。尽管各实践机构能够获得相同水平的认可，但尚不清楚所有的PCMH是否都以相同方式提供医疗服务，以及这些差异如何与患者对其就医体验的评分相关联。
本研究采用混合方法，探究位于南部某州的4家经NCQA认证为3级的PCMH在医疗服务提供方面的差异。此外，该研究还考察了每家诊所与患者对PCMH关键领域评分之间的关联。研究的定性部分包括对每个机构的医疗主任进行深入访谈，以确定每家诊所的PCMH是如何运作的。此外，对1300名成年糖尿病患者进行了关于他们在PCMH就医体验的调查。进行了双变量分析和有序逻辑分析，以确定这4家诊所的PCMH体验有何不同。
深入访谈显示，与其他机构相比，一家诊所（诊所1）具有更强的初级保健导向。此外，这些诊所的患者在所有PCMH领域更有可能给出更高的医疗评分。
本研究表明，并非所有的PCMH诊所都是一样的，这些差异可能会影响患者对其医疗服务的看法。
