Article Figures & Data
Figures
- Figure 1
Patient sample selection process.
a Patients were excluded if they did not have at least 1 previous visit to the health center in the past year, were unaccompanied minors, or if the quota for special populations had already been met (ie, homeless, farm worker, public housing resident).
Tables
Attribute 2009 Health Center Patient Survey Item Access to care How well is health center doing regarding ability to get in to be seen? How well is health center doing regarding hours center is open? How well is health center doing regarding convenience of center’s location? How well is health center doing regarding prompt return of calls? How well is health center doing regarding time in waiting room? How well is health center doing regarding time in examination room? How well is health center doing regarding waiting time for test results? Health center ever helped arrange medical appointments? [excluded from factor analysis because of low correlation] In past 12 months, delayed/unable to get medical care? [excluded from factor analysis because of low correlation] Usual source of care when sick? [excluded from factor analysis because of low correlation] Patient-centered communication Clinician staff (eg, physicians, dentists, physician assistants, nurse practitioners) listens to you? Clinician staff takes enough time with you? Clinician staff explains what you want to know? Nurses and medical assistants answer your questions? Nurses and medical assistants are friendly and helpful to you? Other staff is friendly and helpful to you? Other staff answers your questions? Self-management support (chronic disease management, behavioral risks)a At least 1 of the following among patients with high cholesterol: Ever been told by a doctor or other health professional…to eat fewer high-fat or high-cholesterol foods? Ever been told by a doctor or other health professional…to control your weight or lose weight? Ever been told by a doctor or other health professional…to increase your physical activity or exercise? At least 1 of the following among patients with high blood pressure: Ever been told by a doctor or other health professional to…go on a diet or change eating habits to help lower blood pressure? Ever been told by a doctor or other health professional to…cut down on salt or sodium in diet? Ever been told by a doctor or other health professional to…exercise? Ever been told by a doctor or other health professional to…cut down on alcohol use? During last 6 months, received a telephone call to teach how to take care of high blood pressure? During last 6 months, received an appointment with a nurse call to teach how to take care of high blood pressure? During last 6 months, received a visit to teach how to take care of high blood pressure? Any doctor or nurse given a plan to manage own care at home? At least 1 of the following among patients with diabetes: During last 6 months, received a telephone call to teach how to take care of diabetes? During last 6 months, received an appointment with a nurse call to teach how to take care of diabetes? During last 6 months, received a visit to teach how to take care of diabetes? Any doctor or nurse given a plan to manage own care at home? In past 12 months, anyone at health center talk to you about the health risks of smoking and ways to quit? Either of the following among patients who are current drinkers: In past 12 months, discussed alcohol use with your doctor? In past 12 months, doctor asked you about alcohol use? Either of the following among patients who used drugs in past year: In past 12 months, discussed drug use with your doctor? In past 12 months, doctor asked you about drug use? Comprehensive carea Most recent Papanicolaou test? Most recent mammogram? Most recent colorectal cancer screening (sigmoidoscopy, colonoscopy, proctoscopy, blood stool test)? -
↵a Excluded from factor analysis because items are disease or population specific.
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Patient Characteristics and Quality Ratings Value Sociodemographic characteristics Age, mean (SE), y 34.2 (1.0) Sex, % (SE) Male 40.6 (2.2) Female 59.4 (2.2) Race/ethnicity, % (SE) African American/Black, non-Hispanic 21.5 (3.9) Hispanic/Latino 32.0 (4.1) Other, non-Hispanic 8.7 (1.2) White, non-Hispanic 37.8 (4.3) Insurance coverage, % (SE) Private 10.0 (1.2) Medicare 10.0 (0.9) Medicaid 32.5 (3.3) Other 11.0 (1.7) Uninsured 36.5 (3.3) Language, % (SE) English 79.0 (3.3) Spanish 21.0 (3.3) Federal poverty level, % (SE) <100% FPL 53.4 (2.4) 100–200% FPL 31.6 (2.4) >200% FPL 15.0 (2.0) Education level, % (SE) High school or higher 53.0 (2.9) Less than high school 47.0 (2.9) General health status, % (SE) Excellent/very good/good 67.7 (2.0) Fair/poor 32.3 (2.0) PCMH attributes, mean score (SE)a Access to care: getting there (range 0–4) 3.7 (0.03) Access to care: during the visit (range 0–3) 2.4 (0.04) Patient-centered communication: with clinicians (range 0–3) 2.9 (0.02) Patient-centered communication: with support staff (range 0–4) 3.8 (0.03) Self-management support: chronic diseases (range 0–3) 2.7 (0.03) Self-management support: behavioral risks (range 0–3) 1.5 (0.05) Comprehensive care: preventive services (range 0–3) 2.2 (0.05) Patient ratings of quality of care Overall quality of services, % (SE) Excellent 52.9 (2.0) Very good 30.6 (1.9) Good 14.2 (2.0) Fair 1.8 (0.5) Poor 0.5 (0.3) Quality of physician advice and treatment, % (SE) Excellent 52.2 (1.8) Very good 29.1 (1.5) Good 15.6 (1.3) Fair 2.5 (0.5) Poor 0.6 (0.3) Referrals of friends and relatives to health center, % (SE) Very likely 84.3 (1.6) Somewhat likely 11.5 (1.1) Not very likely 2.2 (0.6) Not at all likely 2.0 (0.6) -
FPL=federal poverty level; SE=standard error.
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↵a Higher score indicates a more positive rating for each attribute.
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- Table 3
Associations Between Patient Ratings of Quality of Care and Perceived Primary Care Medical Home (PCMH) Attributes
Mean (Standard Error) Perception of Overall Quality of Services Perception of Quality of Clinician Advice and Treatment Likelihood of Referring Friends and Relatives to Health Center PCMH Attributesa Excellent/Very Good Good/Fair/Poor P Value Excellent/Very Good Good/Fair/Poor P Value Very Likely Somewhat/Not Very/Not at All Likely P Value Access to care Getting there (0–4 scale) 3.8 (0.02) 3.0 (0.10) <.0001 3.8 (0.03) 3.2 (0.07) <.0001 3.8 (0.03) 3.1 (0.12) <.0001 During the visit (0–3 scale) 2.6 (0.04) 1.6 (0.07) <.0001 2.6 (0.04) 1.7 (0.07) <.0001 2.6 (0.04) 1.7 (0.07) <.0001 Patient-centered communication With clinicians (0–3 scale) 3.0 (0.01) 2.3 (0.09) <.0001 3.0 (0.01) 2.4 (0.08) <.0001 2.9 (0.01) 2.4 (0.10) <.0001 With support staff (0–4 scale) 3.9 (0.02) 3.2 (0.13) <.0001 3.9 (0.02) 3.4 (0.11) <.0001 3.9 (0.02) 3.3 (0.12) <.0001 Self-management support Chronic diseases (0–3 scale) 2.7 (0.03) 2.7 (0.10) .6121 2.8 (0.02) 2.6 (0.11) <.0001 2.7 (0.03) 2.7 (0.09) .7220 Behavioral risks (0–3 scale) 1.5 (0.06) 1.4 (0.14) .1322 1.5 (0.06) 1.4 (0.15) .0497 1.6 (0.06) 1.3 (0.16) .0001 Comprehensive care Preventive services (0–3 scale) 2.2 (0.06) 2.3 (0.10) .1987 2.2 (0.06) 2.3 (0.10) .0053 2.2 (0.06) 2.3 (0.09) .4105 -
↵a The higher the scale value, the better the patient rating for each PCMH attribute.
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Unadjusted OR (95% CI) Adjusted OR (95% CI)a PCMH Attributes Perception of Overall Quality of Servicesb Perception of Quality of Clinician Advice and Treatmentb Likelihood of Referring Friends and Relativesc Perception of Overall Quality of Servicesb Perception of Quality of Clinician Advice and Treatmentb Likelihood of Referring Friends and Relativesc Access to care Getting there 1.82 (1.04–3.21)d 1.33 (0.87–2.04) 1.57 (0.96–2.57) 1.96 (1.18–3.28)e 1.46 (0.88–2.43) 1.72 (1.08–2.72)d During the visit 1.80 (1.40–2.31)f 1.70 (1.42–2.04)f 1.63 (1.26–2.11)f 1.76 (1.37–2.26)f 1.83 (1.35–2.47)f 1.65 (1.38–1.97)f Patient-centered communication With clinicians 3.18 (1.84–5.50)f 3.54 (2.33–5.37)f 2.17 (1.44–3.28)f 3.10 (2.01–4.79)f 4.16 (2.33–7.43)f 2.03 (1.30–3.19)e With support staff 1.50 (1.16–1.94)e 1.23 (0.96–1.58) 1.43 (1.20–1.70)f 1.61 (1.20–2.18)e 1.34 (0.94–1.90) 1.64 (1.29–2.10)f Self-management support Chronic diseases 0.76 (0.46–1.26) 1.26 (0.99–1.60) 0.88 (0.61–1.28) 0.67 (0.39–1.16) 1.26 (0.95–1.68) 0.84 (0.53–1.32) Behavioral risks 0.93 (0.78–1.12) 0.98 (0.79–1.20) 1.08 (0.90–1.30) 0.94 (0.75–1.18) 0.90 (0.77–1.05) 1.06 (0.90–1.24) Comprehensive care Preventive services 1.06 (0.85–1.32) 0.94 (0.78–1.13) 1.06 (0.86–1.32) 0.94 (0.76–1.16) 0.74 (0.58–0.95)d 0.93 (0.70–1.24) -
OR=odds ratio; PCMH=patient-centered medical home.
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↵a Adjusted models include covariates for age, sex, race/ethnicity, language, poverty level, education, insurance coverage type, and health status.
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↵b Excellent/very good vs good/fair/poor.
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↵c Very likely vs somewhat/not very/not at all likely.
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↵d P <.05.
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↵e P <.01.
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↵f P <.001.
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Supplemental Tables 1-3
Supplemental Table 1. Results of Factor Analysis (4 factors); Supplemental Table 2. Bivariate Correlation for Access to Care and Patient-Centered Communication (14 variables); Supplemental Table 3. Bivariate Correlation Coefficients Among 4 Factors
Files in this Data Supplement:
- Supplemental data: Table 1 - PDF file, 1 page, 119 KB
- Supplemental data: Table 2 - PDF file, 1 page, 118 KB
- Supplemental data: Table 3 - PDF file, 1 page, 108 KB
The Article in Brief
Effects of Patient-Centered Medical Home Attributes on Patients' Perceptions of Quality in Federally Supported Health Centers
Lydie A. Lebrun-Harris , and colleagues
Background The patient-centered medical home (PCMH) is a team-based approach to patient care. Several PCMH transformation projects are underway in US federally supported community health centers to improve quality of care. This study assesses patient ratings of PCMH attributes and overall quality of care within health centers.
What This Study Found Patients in community health centers generally report high quality of care, according to data from a nationally representative survey of more than 4,500 patients. Eighty-four percent of patients surveyed reported excellent or very good overall quality of services; 81 percent reported excellent or very good quality of clinician care; and 84 percent said they were very likely to refer friends and relatives. Higher patient ratings of access to care and patient-centered communication were associated with higher odds of positive ratings of care.
Implications
- Clinicians seeking to improve patients' overall perceptions of health care experiences should focus on improving patients' access to care before and during the visit and on promoting clinician and support staff communication skills, according to the authors.
