Patient Experience of Chronic Illness Care and Medical Home Transformation in Safety Net Clinics

Health Serv Res. 2018 Feb;53(1):469-488. doi: 10.1111/1475-6773.12608. Epub 2017 May 30.

Abstract

Objective: To examine the relationship between medical home transformation and patient experience of chronic illness care.

Study setting: Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative.

Study design: Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271).

Data collection methods: Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention.

Principal findings: In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β = 7.7, 95 percent confidence interval [CI]: -1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1-14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination).

Conclusions: We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics.

Keywords: Primary care; chronic disease; chronic illness; chronic illness care; medical home; patient experience; patient satisfaction; patient-centered medical home; patient-oriented measures; primary care redesign; safety net clinics; vulnerable populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chronic Disease / therapy*
  • Continuity of Patient Care / organization & administration
  • Cross-Sectional Studies
  • Female
  • Health Services Research
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Patient Participation
  • Patient Satisfaction
  • Patient-Centered Care / organization & administration*
  • Primary Health Care / organization & administration*
  • Quality of Health Care / organization & administration*
  • Safety-net Providers / organization & administration*
  • Socioeconomic Factors
  • Young Adult