Burnet Deborah, Gunter Kathryn E, Nocon Robert S, Gao Yue, Jin Janel, Fairchild Paige, Chin Marshall H
*Section of General Internal Medicine, Departments of Medicine and Pediatrics University of Chicago †Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL ‡Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2014 Nov;52(11 Suppl 4):S56-63. doi: 10.1097/MLR.0000000000000238.
The patient-centered medical home (PCMH) has roots in pediatrics, yet we know little about the experience of pediatric patients in PCMH settings.
To examine the association between clinic PCMH characteristics and pediatric patient experience as reported by parents.
We assessed the cross-sectional correlation between clinic PCMH characteristics and pediatric patient experience in 24 clinics randomly selected from the Safety Net Medical Home Initiative, a 5-state PCMH demonstration project. PCMH characteristics were measured with surveys of randomly selected providers and staff; surveys generated 0 (worst) to 100 (best) scores for 5 subscales, and a total score. Patient experience was measured through surveying parents of pediatric patients. Questions from the Consumer Assessment of Healthcare Providers and Systems-Clinician and Group instrument produced 4 patient experience measures: timeliness, physician communication, staff helpfulness, and overall rating. To investigate the relationship between PCMH characteristics and patient experience, we used generalized estimating equations with an exchangeable correlation structure.
We included 440 parents and 214 providers and staff in the analysis. Total PCMH score was not associated with parents' assessment of patient experience; however, PCMH subscales were associated with patient experience in different directions. In particular, quality improvement activities undertaken by clinics were strongly associated with positive ratings of patient experience, whereas patient care management activities were associated with more negative reports of patient experience.
Future work should bolster features of the PCMH that work well for patients while investigating which PCMH features negatively impact patient experience, to yield a better patient experience overall.
以患者为中心的医疗之家（PCMH）起源于儿科学，但我们对儿科患者在PCMH环境中的体验了解甚少。
探讨诊所PCMH特征与家长报告的儿科患者体验之间的关联。
我们评估了从“安全网医疗之家倡议”（一个五州的PCMH示范项目）中随机选取的24家诊所的PCMH特征与儿科患者体验之间的横断面相关性。PCMH特征通过对随机选取的医护人员进行调查来衡量；调查为5个分量表和一个总分生成了从0（最差）到100（最好）的分数。患者体验通过对儿科患者的家长进行调查来衡量。来自“医疗服务提供者和系统消费者评估-临床医生及团队”工具的问题产生了4项患者体验指标：及时性、医生沟通、工作人员的帮助程度和总体评分。为了研究PCMH特征与患者体验之间的关系，我们使用了具有可交换相关结构的广义估计方程。
我们纳入了440名家长以及214名医护人员进行分析。PCMH总分与家长对患者体验的评估无关；然而，PCMH分量表在不同方面与患者体验相关。特别是，诊所开展的质量改进活动与患者体验的积极评分密切相关，而患者护理管理活动与更多负面的患者体验报告相关。
未来的工作应加强对患者有效的PCMH特征，同时研究哪些PCMH特征会对患者体验产生负面影响，以总体上产生更好的患者体验。
