Medical Home Transformation: A Gradual Process and a Continuum of Attainment

Article Figures & Data

Table 1

Sample Questions From the Physician Practice Connections Research Survey, for Various Chronic Care Model Domains

Domain	Sample Question
Decision Support	Does your clinic have a system to provide alerts about clinically important abnormal test results to the doctors at the time they are received?
Clinical Information System	Does your clinic maintain a registry (a list of patients with a particular condition along with associated clinical data for each patient) for diabetes?
Self-Management Support	Does your clinic have a systematic approach to identify and remind patients with chronic illnesses who are due for a follow- up visit?
Delivery System Redesign	Does your clinic have nonphysician staff who are specially trained and designated to educate patients in managing their illness?
Health Care Organization	Does your clinic conduct or participate in formal quality improvement activities?

Note: The answers for each question were No (scored as 0), Yes, but needs improvement (0.5), or present and works well (1.0).

Table 2

Characteristics of the Adult Certified Health Care Homes (N = 102)

Characteristic	No. (%)
Location
Metropolitan	65 (63.7)
Nonmetropolitan	37 (36.3)
Ownership
Health system	97 (95.1)
Health plan	4 (3.9)
Physicians	1 (1.0)
Medical services
Primary care only	40 (39.2)
Primary care and some specialty	13 (12.8)
Multispecialty	49 (48.0)
Primary care physicians, No.
1–3	13 (12.8)
4–7	43 (42.2)
8–10	22 (21.6)
≥11	22 (21.6)
Nurse practitioners and physician assistants, No.
0	8 (7.8)
1–3	58 (56.9)
≥4	21 (20.6)
Clinics in medical group, No.
1	6 (5.9)
2–4	6 (5.9)
5–10	9 (8.8)
11–20	2 (1.7)
≥21	77 (75.5)
Patient visits/week
<350	21 (20.6)
350–549	27 (26.5)
550–999	27 (26.5)
≥1,000	27 (26.5)
Medical records
Fully electronic	94 (92.2)
Paper and electronic	6 (5.9)
Paper only	0 (0)
	Mean (SD)

Patient insurance
Commercial	63.3 (22.9)
Medicare	17.3 (10.4)
Medicaid	14.3 (15.0)
Uninsured	3.5 (6.3)

Table 3

Practice Systems Scores and Quality Measure Rates for Diabetes and Vascular Disease

	3 Years Ago		Now		Change

Score or Measure	Mean (SD)	Range	Mean (SD)	Range	Mean (SD)	Range
PPC-RS score, points^a	38.8 (16.5)	10.0 to 81.0	68.0 (14.1)	28.5 to 97.1	29.1 (16.7)	−1.0 to 62.9
Health care organization	61.3 (32.2)	0.0 to 100.0	82.3 (22.6)	0.0 to 100.0	21.1 (26.1)	0.0 to 100.0
Delivery system redesign	24.0 (17.0)	0.0 to 78.3	58.0 (20.3)	13.0 to 100.0	34.0 (23.6)	−4.3 to 89.1
Clinical information systems	40.1 (20.9)	4.8 to 100.0	73.6 (18.9)	23.8 to 100.0	33.4 (20.7)	0.0 to 73.8
Decision support	54.7 (23.1)	6.7 to 100	80.1 (14.8)	26.7 to 100.0	25.4 (19.7)	0.0 to 76.7
Self-management support	39.1 (16.4)	0.0 to 83.8	63.2 (16.2)	0.0 to 91.9	24.1 (15.2)	−4.0 to 59.5
Optimal diabetes rate, %	22.0 (8.5)	3.8 to 52.0	24.4 (7.9)	5.9 to 41.4	2.1 (5.5)	−12.0 to 21.0
Optimal vascular rate, %	37.5 (9.8)	10.0 to 57.9	41.6 (11.2)	10.6 to 63.6	4.4 (7.5)	−15.7 to 27.1

PPC-RS = Physician Practice Connections Research Survey.
↵a Possible range of scores: 0 to 100.
Notes: Numbers of clinics for each score/measure ranged from 98 to 102, as some had missing data. Optimal diabetes rate = percentage of patients with diabetes meeting all thresholds for control of hemoglobin A_1c, blood pressure, and lipids as well as aspirin use and tobacco abstinence. Optimal vascular rate = percentage of patients with heart disease meeting all thresholds for control of blood pressure and lipids as well as aspirin use and tobacco abstinence.