Vander Schaaf Emily B, Dellon Elisabeth P, Carr Rachael A, deJong Neal A, Skinner Asheley C, Steiner Michael J
Division of General Pediatrics and Adolescent Medicine, University of North Carolina, Department of Pediatrics, 231 MacNider Building, CB #7225, Chapel Hill, NC 27599-7220. E-mail:
Am J Manag Care. 2017 Feb 1;23(2):e70-e74.
The patient-centered medical home (PCMH) strives to improve the quality of care in the primary care setting. Recently, certification programs for patient-centered coordinated care have expanded to subspecialty care. Children with chronic conditions are particularly in need of patient-centered and coordinated care. Our objective was to compare parent perceptions of PCMH elements at primary care and specialty practices for children receiving specialty care.
Cross-sectional survey study.
We surveyed the parents of children returning for specialty care in a hospital-based pediatric subspecialty clinic on the presence of National Committee for Quality Assurance (NCQA) PCMH elements in their primary care practice and in their main specialty care practice.
More parents perceived good appointment access at primary care practices than they did at specialty practices (93% vs 87%, respectively; P <.001). They perceived good care coordination and referral follow-up both at primary care and specialty practices (89% vs 88% and 92% vs 92%, respectively). However, parents less frequently perceived the presence of 7 other PCMH elements at primary care practices compared with specialty practices; these included appointment and tests due reminders, distributing handouts, electronic prescribing, sharing test results, surveying experiences, and e-mail capability.
Despite an emphasis on PCMHs in primary care settings, parents of children seeking specialty care are more likely to perceive the presence of NCQA PCMH elements in specialty rather than primary care clinics. Future PCMH efforts should address parents' perceptions and interpretations of these services.
以患者为中心的医疗之家（PCMH）致力于提高初级保健机构的医疗质量。最近，以患者为中心的协调护理认证项目已扩展至专科护理领域。患有慢性病的儿童尤其需要以患者为中心的协调护理。我们的目的是比较接受专科护理的儿童的家长对初级保健机构和专科医疗机构中PCMH要素的看法。
横断面调查研究。
我们对一家医院儿科专科门诊复诊的儿童家长进行了调查，询问他们在初级保健机构和主要专科医疗机构中是否存在美国国家质量保证委员会（NCQA）的PCMH要素。
更多家长认为初级保健机构的预约更便捷，而非专科医疗机构（分别为93%和87%；P<.001）。他们认为初级保健机构和专科医疗机构在护理协调和转诊跟进方面都做得很好（分别为89%对88%和92%对92%）。然而，与专科医疗机构相比，家长较少认为初级保健机构存在其他7项PCMH要素；这些要素包括预约和检查到期提醒、发放宣传资料、电子处方、共享检查结果、调查就医体验以及电子邮件功能。
尽管初级保健机构强调PCMH，但寻求专科护理的儿童家长更有可能认为NCQA的PCMH要素存在于专科诊所而非初级保健诊所。未来PCMH的工作应关注家长对这些服务的看法和理解。
