Article Figures & Data
Tables
Recognition Level Characteristic Overall (N=249) Level 1 (n=91) Level 3a (n=158) Practice Solo physician practice, % 34.9 40.7 31.7 Physicians/NPs/PAs, mean (SD), No. 2.9 (1.6) 2.7 (1.6) 3.0 (1.5) Total staff (excluding physicians/NPs/PAs), mean (SD), No. 8.2 (5.0) 7.6 (4.8) 8.5 (5.1) Practice type, % Federally designated health center or community health center 14.9 14.3 15.2 Physician owned, independent 20.9 28.5 16.5 Physician owned, affiliated with larger group 27.7 23.1 30.4 Hospital/health system owned 36.5 34.1 38.0 Region, % New England (CT, ME, MA, NH, RI, VT) 24.1 28.6 21.5 Northeast (NY, NJ) 13.7 17.6 11.4 Mid-Atlantic (DC, MD, PA, VA, WV) 10.4 15.4 7.6 Southeast (AL, FL, GA, KY, MS, NC, SC, TN) 20.1 12.1 24.7 Midwest (IL, IN, MI, MN, OH, WI) 18.1 15.4 19.6 Southwest (AR, LA, NM, OK, TX) 7.2 8.8 6.3 Plains (IA, KS, MO, NE) 2.8 2.2 3.2 Mountain (CO, MT, ND, SD, UT, WY) 3.2 0.0 5.1 West (AZ, CA, HI, NV) 0.4 0.0 0.6 Northwest (AK, ID, OR, WA) 0.0 0.0 0.0 Fully electronic health record, %b 79.6 67.5 86.2 Physician Female, % 35.0 33.3 36.0 Race/ethnicity, %c White, non-Hispanic 78.6 80.2 77.7 Black, non-Hispanic 6.0 10.5 3.4 Asian, non-Hispanic 9.8 8.1 10.8 Hispanic 4.7 1.2 6.8 Other/mixed 0.9 0.0 1.3 Time in this practice, mean (SD), y 13.9 (9.0) 14.8 (9.9) 13.3 (8.5) Time since graduation from medical school, mean (SD), yc 23.4 (9.6) 25.5 (9.7) 22.2 (9.4) -
NP=nurse practitioner; PA=physician assistant.
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Note: Pearson χ2 test for categorical variables and independent samples t tests for continuous variables.
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↵a Includes practices that entered the study at Level 3 and practices that advanced from Level 1 to Level 3 during the study.
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↵b P <.01, difference by level.
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↵c P <.05, difference by level.
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Recognition Level Change Driver Overall (N=249) Level 1 (n=91) Level 3a (n=158) Priority for “making practice more of a patient-centered medical home,”b % 29.8 24.4 32.9 Motivations for PCMH, mean (SD) ratingc To improve quality of patient care 4.4 (0.9) 4.3 (1.0) 4.4 (0.9) To improve patient experiences of care 4.4 (0.9) 4.3 (1.3) 4.4 (0.8) To function more efficiently 4.1 (1.2) 4.1 (1.1) 4.0 (1.2) To become eligible for financial incentives 4.0 (1.1) 4.1 (1.1) 3.9 (1.1) To meet expectations/requirements set by our medical group or delivery system 3.9 (1.2) 4.0 (1.2) 3.9 (1.3) To improve clinician experience 3.6 (1.3) 3.5 (1.4) 3.6 (1.3) To meet expectations/requirements from my specialty society or board 2.8 (1.5) 3.0 (1.4) 2.7 (1.5) Barriers to PCMH implementation, mean (SD) ratingc Timed 3.7 (1.2) 3.9 (1.2) 3.6 (1.2) Money and other resources to invest in staff, training, or equipmente 3.3 (1.3) 3.6 (1.3) 3.1 (1.3) Information systemsd 2.7 (1.3) 3.0 (1.4) 2.5 (1.3) Knowledge and experience 2.5 (1.1) 2.7 (1.2) 2.4 (1.1) Clinician/staff resistance to change 2.4 (1.2) 2.5 (1.2) 2.3 (1.2) Clinician/staff turnover 1.9 (1.2) 1.8 (1.3) 2.0 (1.2) -
PCMH=patient-centered medical home.
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Note: Pearson χ2 test for categorical variables and independent samples t tests for continuous variables.
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↵a Includes practices that entered the study at Level 3 and practices that advanced from Level 1 to Level 3 during the study.
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↵b Rating of 9 or 10 on scale of 0 to 10.
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↵c Range: 1 to 5, with higher ratings indicating greater barrier.
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↵d P <.05, difference by level.
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↵e P <.01, difference by level.
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- Table 3
Participation in Demonstration Projects, Receipt of Payment, and Type of Help for Patient-Centered Medical Home Implementation
Recognition Level Measure Overall (N=249) Level 1 (n=91) Level 3a (n=158) Participate in demonstration/pilot project and/or received payment for being PCMH, % responding yesb Did not participate in a project or receive payment 21.7 14.3 26.0 Participated in project only 8.8 11.0 7.6 Received payment for PCMH only 24.1 33.0 19.0 Both participated and received PCMH payment 45.4 41.8 47.5 Received help for PCMH implementation, % yes Training for staff 85.5 81.8 87.7 Training for clinicians 84.2 82.0 85.4 Training for patients/consumer advocates 31.4 28.4 33.1 Consultation/coaching/facilitation specific to practice 63.9 61.6 65.2 Access to a learning collaborative 59.3 55.7 61.4 Training on how to meet NCQA’s recognition requirementsb 81.3 87.8 77.6 Assistance with preparing documentation of application requirements for NCQA’s recognition program 81.0 86.5 77.8 Of those who received help, % who found it very useful Training for staff 43.5 44.4 43.0 Training for clinicians 41.1 38.4 42.5 Training for consumer advocates 31.6 20.0 37.3 Consultation/coaching/facilitation specific to your practice 47.4 52.8 44.6 Access to a learning collaborative 43.4 51.0 39.4 Training on how to meet NCQA’s recognition requirements 52.5 50.6 53.7 Assistance with preparing documentation of application requirements for NCQA’s recognition program 67.4 63.6 69.8 Recognition Level Strategy Overall (N=249) Level 1 (n=91) Level 3a (n=158) Use of specific strategies, % reporting that it worked well Changing or creating systems in the practice that make it easier to provide high-quality care 86.5 82.2 89.0 Providing information and skills training to clinicians and staffb 79.0 70.3 84.1 Designing care improvements to make the care process more beneficial to the patient 78.9 82.4 76.7 Periodically measuring care quality to assess compliance with any new approach to care 76.0 72.2 78.2 Setting goals and benchmarking rates of performance quality 73.6 71.1 75.0 Including front-line staff on quality improvement committees or teams 69.1 65.9 71.0 Removing or reducing barriers to better quality of care 65.6 63.3 66.9 Providing to those who are charged with implementing improved care the power to authorize and make the desired changesb 64.9 55.6 70.3 Delegating to nonclinician staff the responsibility to carry out aspects of care that were the responsibility of cliniciansb 63.9 55.6 68.8 Organizing people into teams focused on accomplishing the change process for improved care 60.9 58.0 62.6 Reporting measurements of individual clinician performance for comparison with peer cliniciansc 60.3 48.9 66.9 Using opinion leaders or role modeling or other strategies to encourage support for changes 57.3 54.4 59.0 Using piloting or pretesting of changes and evaluating the impact before introducing practicewide changesc 51.4 38.2 59.0 Designing care improvements to make physician participation less work than beforeb 46.9 38.9 51.6 Providing training to clinicians and staff on how to involve patients/families in quality improvement 30.1 27.4 31.6 Using formal quality improvement or efficiency approaches (eg, Lean, Plan-Do-Study-Act, rapid cycles, Six Sigma, Model for Improvement) 30.5 26.7 32.9 Including patients on quality improvement committees or teams 15.5 12.1 17.5 Overall score, mean (SD)b 11.5 (3.8) 10.7 (4.1) 11.9 (3.5) -
Note: Pearson χ2 test for categorical variables and independent samples t tests for continuous variables.
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↵a Includes practices that entered the study at Level 3 and practices that advanced from Level 1 to Level 3 during the study.
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↵b P <.05, difference by level.
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↵c P <.01, difference by level.
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d Range: 0 to 18, with higher scores indicating greater use of strategies.
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Recognition Level Item Overall (N=249) Level 1, % (n=91) Level 3,a % (n=158) The clinicians in our practice adhere to practice policies. 83.3 82.2 83.9 The leaders of our efforts to improve care quality are enthusiastic about their task.b 82.3 74.4 86.7 The clinicians in our practice espouse a shared mission and policies. 79.8 75.8 82.1 The working environment in our practice is collaborative and cohesive, with a shared sense of purpose, cooperation, and willingness to contribute to the common good. 77.4 76.9 77.1 When making changes at our practice, we choose new processes of care that are more advantageous than the old for everyone involved (patients, clinicians, and our entire practice). 68.7 71.1 67.3 The thinking of our leadership is strongly oriented toward systems. 68.0 61.1 72.1 We have greatly improved the quality of care in the past year. 67.3 61.1 70.9 We have many clinician and staff champions interested in leading the improvement of care quality. 64.2 58.4 67.5 Most of the other health care resources in our community (hospitals, community groups, specialist offices) are supportive of the medical home concept. 59.5 59.6 59.5 Our practice operations rely heavily on organized systems.b 58.5 48.9 64.1 Our practice attaches more priority to quality of care than to finances. 57.7 62.5 55.1 We have received feedback from patients that they have benefited from the changes we have made. 56.5 53.3 58.2 Our practice is undergoing considerable stress as the result of internal changes. (reverse coded) 41.9 47.2 38.9 Our resources (personnel, time, financial) are too tightly limited to improve care quality now. (reverse coded)b 21.1 28.1 17.2 Overall score, mean (SD)b,c 9.5 (3.0) 9.0 (3.2) 9.8 (2.8) -
Note: Values are percentage that agree or strongly agree. Pearson χ2 test for categorical variables and independent samples t tests for continuous variables.
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↵a Includes practices that entered the study at Level 3 and practices that advanced from Level 1 to Level 3 during
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↵b P <.05, difference by level.
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↵c Range: 1 to 14, with higher scores indicating greater change ability.
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Additional Files
Supplemental Appendix & Figures 1-2
Supplemental Appendix. Contextual Factors; Figure 1. Number of NCQA-recognized patient-centered medical home (PCMH) practices by state (as of October 31, 2012); Figure 2. States with public and private patient-centered medical home (PCMH) initiatives that use NCQA recognition.
Files in this Data Supplement:
- Supplemental data: Appendix & Figures - PDF file, 4 pages, 1.3MB