The patient-centered medical home (PCMH) has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve health care quality and patient experience. A retrospective cohort study conducted by Dr. Haichang Xin, research associate in the department of health care organization and policy at the University of Alabama at Birmingham — in collaboration with department colleagues Dr. Meredith Kilgore, professor and chair, and Dr. Bisakha Sen, professor — examines how patient perceived PCMH is related to patient satisfaction and experience nationwide. It advances academic discussion in that it is among the first to examine empirical evidence using a U.S. nationally representative sample.
Assessing data from the 2010 to 2011 Medical Expenditure Panel Survey focused on insured individuals ages 18 years and older, the researchers measured and identified cohorts for a “full PCMH,” a “partial PCMH” (i.e., with a usual source of care but not a PCMH), and an “unknown PCMH,” with the reference group being the “no regular provider” group and the partial PCMH group, respectively. Using logit models, the team assessed patient experiences of the PCMH use controlling for covariates in 2010. Given the nature of the complex survey design, the weights and variance were adjusted using the survey procedures to yield nationally representative results.
The final study sample consisted of 7,743 individuals, representing 191 million individuals in the weighted population. After controlling for covariates in 2010, the full PCMH group was consistently observed to have significantly higher odds of positive patient experience than individuals with no usual source of care (p<0.01): odds ratio (OR) = 1.89 for providers who “listened carefully to you”; OR = 1.81 for providers who “spent enough time with you”; OR = 1.85 for providers who “showed respect for what you had to say”; and OR = 1.89 for the composite patient experience. Similarly, compared with the partial PCMH group, consistently significantly higher odds of patient satisfaction among all patient experience measures were observed for the full medical home group (p<0.05): OR = 1.45 (p=0.070, significant at α=0.1 level) for providers who “explained things so you understood”; OR = 1.69 for providers who “listened carefully to you”; OR = 1.57 for providers who “spent enough time with you”; OR = 1.48 for providers who “showed respect for what you had to say”; and OR = 1.56 for the composite patient experience. Overall, the PCMH model was associated with improved patient satisfaction nationwide. Findings from this study have shed light on strategies of innovative healthcare delivery models in improving patient experience, which in turn, may translate to patients’ compliance to treatment regimen and improved health outcomes.
“Is Access to and Use of Primary Care Practices that Patients Perceive as Having Essential Qualities of a Patient-Centered Medical Home Associated With Positive Patient Experience? Empirical Evidence From a U.S. Nationally Representative Sample” was published online in April in the Journal for Healthcare Quality.