Differences in patient ratings of medical home domains among adults with diabetes: comparisons across primary care sites.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

This study demonstrates that not all PCMH clinics are alike and that these differences can possibly affect patient perceptions of their care.